Which is more likely to cover common pathogens of cellulitis, Clindamycin (clindamycin) or Augmentin (amoxicillin-clavulanate)

From the Guidelines

Clindamycin is more likely to cover common pathogens of cellulitis, including MRSA, compared to Augmentin (amoxicillin-clavulanate) in most cases, especially in areas with high MRSA prevalence. For empiric treatment of cellulitis, clindamycin is often the preferred choice due to its effectiveness against MRSA and other gram-positive bacteria, which are common causative organisms in cellulitis 1. The typical adult dose of clindamycin is 300-450 mg orally three times a day for 5-7 days, depending on the severity of the infection.

Some key points to consider:

• Clindamycin provides coverage against both Streptococcus and Staphylococcus species, including MRSA, which is a common cause of cellulitis 1.
• Augmentin (amoxicillin-clavulanate) has a broader spectrum of activity, but its effectiveness against MRSA is limited, and it may not be the best choice in areas with high MRSA prevalence 1.
• The choice of antibiotic may vary depending on local resistance patterns, the severity of the infection, and patient factors such as allergies or risk for MRSA 1.
• It's essential to consider local guidelines and patient-specific factors when selecting an antibiotic for cellulitis treatment 1.

In terms of specific recommendations:

• For nonpurulent cellulitis, clindamycin or a b-lactam antibiotic (such as cephalexin or dicloxacillin) may be used, with clindamycin providing coverage for both b-hemolytic streptococci and CA-MRSA 1.
• For purulent cellulitis, clindamycin, TMP-SMX, doxycycline, or linezolid may be used, with clindamycin being a good option due to its effectiveness against MRSA 1.
• For complicated SSTI, vancomycin, linezolid, daptomycin, or telavancin may be used, with clindamycin being an option in some cases 1.

From the FDA Drug Label

Clindamycin is indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci Clindamycin has been shown to be active against most of the isolates of the following microorganisms, both in vitro and in clinical infections: Gram-positive bacteria Staphylococcus aureus (methicillin-susceptible strains) Streptococcus pneumoniae (penicillin-susceptible strains) Streptococcus pyogenes Amoxicillin/clavulanic acid has been shown to be active against most isolates of the following bacteria, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section Gram-positive bacteria Staphylococcus aureus Gram-negative bacteria Enterobacter species Escherichia coli Haemophilus influenzae Klebsiella species Moraxella catarrhalis At least 90 percent of the following bacteria exhibit an in vitro minimum inhibitory concentration (MIC) less than or equal to the susceptible breakpoint for amoxicillin/clavulanic acid. However, the efficacy of amoxicillin/clavulanic acid in treating clinical infections due to these bacteria has not been established in adequate and well-controlled clinical trials Gram-positive Bacteria Enterococcus faecalis Staphylococcus epidermidis Staphylococcus saprophyticus Streptococcus pneumoniae Streptococcus pyogenes

Common pathogens of cellulitis are typically streptococci and staphylococci.

• Clindamycin is effective against streptococci and staphylococci, including methicillin-susceptible strains of Staphylococcus aureus.
• Amoxicillin-clavulanate is also effective against streptococci and staphylococci, including Staphylococcus aureus. Based on the provided information, both Clindamycin and Amoxicillin-clavulanate can cover common pathogens of cellulitis, but the choice of antibiotic should be based on local epidemiology, susceptibility patterns, and specific patient factors 2, 3.

From the Research

Comparison of Clindamycin and Augmentin for Cellulitis Treatment

• Clindamycin is effective against a wide range of pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), which is a common cause of cellulitis 4, 5, 6.
• Augmentin (amoxicillin-clavulanate) has a broader spectrum of activity against Gram-negative bacteria, but its effectiveness against MRSA is limited 6.
• A study comparing clindamycin and trimethoprim-sulfamethoxazole for uncomplicated skin infections, including cellulitis, found similar cure rates for both treatments 5.
• Another study found that clindamycin was more effective than cephalexin in patients with MRSA infections, moderately severe cellulitis, and obesity 4.
• Weight-based dosing of clindamycin and trimethoprim-sulfamethoxazole is important for optimal treatment outcomes in cellulitis, with inadequate dosing associated with clinical failure 7.

Pathogen Coverage

• Clindamycin covers a wide range of Gram-positive cocci, including MRSA, which is a common cause of cellulitis 4, 5, 6.
• Augmentin has a broader spectrum of activity against Gram-negative bacteria, but its effectiveness against MRSA is limited 6.
• The choice of antibiotic should be based on the suspected or confirmed pathogen, as well as local resistance patterns 6.

Treatment Outcomes

• Clindamycin has been shown to be effective in treating cellulitis, with cure rates similar to those of trimethoprim-sulfamethoxazole 5.
• Augmentin may not be the best choice for treating cellulitis, especially in areas with high rates of MRSA infection, due to its limited effectiveness against this pathogen 6.
• Weight-based dosing of clindamycin and trimethoprim-sulfamethoxazole is important for optimal treatment outcomes in cellulitis, with inadequate dosing associated with clinical failure 7.