What is the recommended dose of Augmentin (amoxicillin-clavulanate) for treating an abscess?

Augmentin Dosing for Abscess Treatment

For treating an abscess, the recommended dose of Augmentin (amoxicillin-clavulanate) in adults is 875 mg/125 mg orally twice daily or 500 mg/125 mg orally three times daily for 5-6 days.

Dosing Recommendations

Adults:

• First-line regimen: 875 mg/125 mg tablet every 12 hours OR 500 mg/125 mg tablet every 8 hours 1
• Duration: 5-6 days for uncomplicated skin infections 2
• Take at the start of a meal to minimize gastrointestinal intolerance 1

Children:

• Age ≥12 weeks (3 months):
  • For more severe infections: 45 mg/kg/day divided every 12 hours OR 40 mg/kg/day divided every 8 hours 1
  • For less severe infections: 25 mg/kg/day divided every 12 hours OR 20 mg/kg/day divided every 8 hours 1
• Children weighing ≥40 kg: Use adult dosing 1

Clinical Considerations

Type of Abscess

• For simple cutaneous abscesses, incision and drainage is the primary treatment, with antibiotics as adjunctive therapy 3
• For complicated skin and soft tissue infections (cSSTI) with abscess formation, antimicrobial therapy should cover both beta-hemolytic streptococci and community-acquired MRSA 3

Microbiology Considerations

• Augmentin provides coverage for both beta-hemolytic streptococci and methicillin-susceptible Staphylococcus aureus (MSSA) 3
• If MRSA is suspected or prevalent in your area (>10-15%), consider alternative agents such as:
  • Trimethoprim-sulfamethoxazole: 1-2 double-strength tablets twice daily
  • Clindamycin: 300-450 mg four times daily
  • Doxycycline: 100 mg twice daily 3

Special Situations

• For patients with severe infections or systemic symptoms, consider:
  • Hospitalization for IV antibiotics 2
  • Surgical debridement for larger or complex abscesses 3
• For immunocompromised patients, broader coverage and longer duration may be necessary 2

Important Caveats

1. Surgical drainage is essential: Incision and drainage is the mainstay of therapy for abscesses and should be performed whenever feasible 3

2. Culture considerations: Cultures of cutaneous aspirates, biopsies, or swabs are not routinely recommended for typical abscesses but should be considered in patients with:

   • Malignancy on chemotherapy
   • Neutropenia
   • Severe cell-mediated immunodeficiency
   • Immersion injuries
   • Animal bites 3

3. Treatment failure: If no improvement is seen within 72 hours, reevaluate and consider:

   • Inadequate drainage
   • Alternative antibiotic therapy
   • Possible MRSA infection 2

4. Previous antibiotic exposure: Patients who have received antibiotics in the previous 4-6 weeks should be given an alternative class or higher-dose regimen 2

5. Avoid common dosing errors:

   • Two 250 mg/125 mg tablets should NOT be substituted for one 500 mg/125 mg tablet (they contain the same amount of clavulanic acid) 1
   • The 250 mg/125 mg tablet and 250 mg/62.5 mg chewable tablet are NOT interchangeable 1

By following these guidelines, most uncomplicated abscesses should resolve with appropriate surgical drainage and antibiotic therapy.