Can Augmentin (amoxicillin/clavulanate) be combined with Doxycycline to treat nasal cellulitis?

Combination of Augmentin and Doxycycline for Nasal Cellulitis

Yes, combining Augmentin (amoxicillin/clavulanate) with doxycycline is an appropriate and effective treatment strategy for nasal cellulitis, particularly when MRSA is a concern or when broad coverage is needed.

Rationale for Combination Therapy

Microbiology of Nasal Cellulitis

• Nasal cellulitis is commonly caused by:
  • Staphylococcus aureus (including MRSA)
  • Streptococcus species
  • Haemophilus influenzae
  • Anaerobic bacteria in some cases

Benefits of This Combination

1. Complementary Coverage:

   • Augmentin provides excellent coverage against streptococci and beta-lactamase producing organisms 1
   • Doxycycline offers good activity against MRSA and atypical organisms 2

2. Resistance Management:

   • This combination addresses the increasing prevalence of beta-lactamase-producing H. influenzae and M. catarrhalis, as well as penicillin-resistant S. pneumoniae 2
   • Doxycycline provides coverage against many MRSA strains that may not respond to Augmentin alone 3

Dosing Recommendations

Adults:

• Augmentin: High-dose amoxicillin/clavulanate (4g/250mg per day divided in two doses) 2
• Doxycycline: 100mg twice daily 2

Duration:

• 10-14 days total, or alternatively 7 days after becoming symptom-free 4

Monitoring and Follow-up

Expected Response:

• Significant improvement should be seen within 72 hours of consistent treatment 4
• If no improvement or worsening occurs after 72 hours, reevaluation is necessary 2

Side Effects to Monitor:

• Gastrointestinal effects (diarrhea, nausea) are common with both medications
• Severe or bloody diarrhea requires immediate medical reassessment 4
• Photosensitivity with doxycycline (advise sun protection)

Special Considerations

When This Combination Is Particularly Useful:

• Patients with severe or moderate disease
• Recent antibiotic use within past 4-6 weeks
• Healthcare-associated infections
• Areas with high MRSA prevalence
• Nasal cellulitis with risk of anaerobic involvement

Contraindications:

• Pregnancy (doxycycline)
• Children under 8 years (doxycycline)
• Severe renal impairment (dose adjustment needed for Augmentin)

Alternative Options

If this combination cannot be used:

• For penicillin allergies: Clindamycin plus a third-generation cephalosporin (cefixime or cefpodoxime) 2
• For severe beta-lactam allergies: Respiratory fluoroquinolones (levofloxacin or moxifloxacin) 2

Clinical Pearls

• Trimethoprim-sulfamethoxazole should not be used as a single agent for cellulitis due to poor streptococcal coverage 2
• Complete the full course of antibiotics even if symptoms improve quickly to prevent resistance development 4
• Consider topical mupirocin for concurrent nasal MRSA colonization in recurrent cases 5
• Ensure adequate hydration and consider probiotics to minimize gastrointestinal side effects 4

This combination therapy approach provides comprehensive coverage against the most likely pathogens in nasal cellulitis while addressing the increasing concern of antimicrobial resistance.