What should I do if my recurrent gluteal infection doesn't fully respond to Augmentin (amoxicillin/clavulanate) while also taking terbinafine?

From the Guidelines

You should consult your healthcare provider promptly for reevaluation if your recurrent gluteal infection isn't fully responding to Augmentin while taking terbinafine. Your doctor may need to collect a culture sample to identify the specific bacteria causing the infection and determine its antibiotic sensitivity 1. Based on these results, they might prescribe a different antibiotic such as trimethoprim-sulfamethoxazole (Bactrim), doxycycline, or clindamycin. The infection may be caused by methicillin-resistant Staphylococcus aureus (MRSA) or another organism resistant to Augmentin.

Some key points to consider in the management of skin and soft tissue infections include:

• The use of antibiotics such as dicloxacillin, cephalexin, or clindamycin for methicillin-susceptible Staphylococcus aureus (MSSA) infections 1
• The consideration of vancomycin, linezolid, or daptomycin for methicillin-resistant Staphylococcus aureus (MRSA) infections 1
• The importance of incision and drainage for abscesses, as antibiotics alone may not be effective in penetrating these fluid collections 1
• The need for good hygiene practices, including keeping the area clean and dry, using antibacterial soap, wearing loose cotton underwear, and avoiding sharing personal items

Your provider might also consider incision and drainage if there's an abscess present, as antibiotics alone often can't penetrate these fluid collections effectively. Additionally, they should evaluate whether the terbinafine (typically used for fungal infections) is necessary or potentially complicating your treatment. Recurrent infections may indicate an underlying condition requiring further investigation, and a 5-day decolonization regimen with intranasal mupirocin, daily chlorhexidine washes, and daily decontamination of personal items may be considered for recurrent S. aureus infection 1.

From the FDA Drug Label

Patients should be counseled that antibacterial drugs, including amoxicillin and clavulanate potassium tablets, should only be used to treat bacterial infections. When amoxicillin and clavulanate potassium tablets are prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed Skipping doses or not completing the full course of therapy may: (1) decrease the effectiveness of the immediate treatment, and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by amoxicillin and clavulanate potassium tablets or other antibacterial drugs in the future

The medication should be taken exactly as directed. If the recurrent gluteal infection doesn't fully respond to Augmentin, consult a physician for further guidance, as the provided information does not directly address the specific scenario of incomplete response to treatment while taking terbinafine 2.

From the Research

Recurrent Gluteal Infection Treatment

If your recurrent gluteal infection doesn't fully respond to Augmentin (amoxicillin/clavulanate) while also taking terbinafine, consider the following:

• The use of terbinafine is well established for dermatophyte infections, but its use in non-dermatophyte or mixed infections has not been fully defined 3, 4, 5.
• Terbinafine has fungicidal activity against a wide variety of dermatophytes, moulds, and certain dimorphic fungi, and fungistatic activity against Candida albicans 3, 4, 5.
• For bacterial skin infections like impetigo, treatment options include topical antibiotics such as mupirocin, retapamulin, and fusidic acid, as well as oral antibiotic therapy with amoxicillin/clavulanate, dicloxacillin, cephalexin, and others 6.
• Methicillin-resistant Staphylococcus aureus (MRSA) is a concern, and formulary interventions can impact the minimum inhibitory concentration of MRSA to mupirocin, chlorhexidine, and octenidine 7.

Potential Next Steps

• Consult with a healthcare professional to determine the best course of treatment for your specific infection.
• Consider alternative antibiotic therapies or combination treatments, taking into account the potential for antibiotic resistance 6, 7.
• Terbinafine may still be effective against certain types of fungal infections, but its use in combination with other antifungal agents may be necessary for non-dermatophytic refractory or resistant yeast/mold infections 5.