Augmentin for Minor Skin Infections
Augmentin (amoxicillin-clavulanate) is effective for treating minor skin infections, particularly those caused by beta-lactamase-producing Staphylococcus aureus, Escherichia coli, and Klebsiella species. 1
Indications and Efficacy
Augmentin is specifically FDA-approved for skin and skin structure infections caused by beta-lactamase-producing organisms 1. This makes it particularly valuable when:
- Mixed infections involving both staphylococci and streptococci are suspected
- Beta-lactamase producing organisms are likely present
- Empiric coverage is needed before culture results are available
Clinical studies have demonstrated high success rates (81-94%) when using Augmentin for skin infections 2, 3. Its effectiveness stems from the combination of amoxicillin with clavulanic acid, which inhibits beta-lactamase enzymes that would otherwise inactivate amoxicillin.
Treatment Guidelines Based on Infection Type
Minor Skin Infections (Impetigo, Small Furuncles)
- First-line therapy: Topical mupirocin 2% ointment 4, 5
- For more extensive disease: Oral antibiotics including Augmentin 4, 5
Infected Wounds, Cellulitis, and Other Skin Infections
- For mild to moderate infections: Augmentin is an appropriate choice 4
- Dosing: Standard adult dosing is 500/125 mg three times daily or 875/125 mg twice daily for 7-10 days
When to Consider Alternative Antibiotics
- For confirmed MRSA infections: Vancomycin, linezolid, or TMP-SMX 4
- For confirmed streptococcal-only infections: Penicillin V 5
- For penicillin allergic patients: Clindamycin or TMP-SMX (note that TMP-SMX has inadequate streptococcal coverage) 5
Advantages of Augmentin for Skin Infections
Augmentin offers several advantages over other antibiotics for skin infections:
- Broad spectrum coverage: Effective against both gram-positive and gram-negative pathogens commonly found in skin infections 1
- Protection against beta-lactamase: The clavulanic acid component inhibits beta-lactamase enzymes, making it effective against resistant organisms 6
- Particularly valuable for mixed infections: In mixed staphylococcal-streptococcal infections, Augmentin has been shown to effectively eliminate both pathogens, while amoxicillin alone failed to eliminate streptococci in the presence of beta-lactamase-producing staphylococci 6
Clinical Pearls and Pitfalls
When to Use Augmentin
- When beta-lactamase producing organisms are suspected
- For moderate skin infections not responding to narrower-spectrum antibiotics
- For mixed infections involving both staphylococci and streptococci
When NOT to Use Augmentin
- Important: When susceptibility testing shows susceptibility to amoxicillin alone (indicating no beta-lactamase production), Augmentin should not be used 1
- For minor, localized skin infections where topical therapy would suffice
- For confirmed MRSA infections (use appropriate MRSA-targeted therapy instead)
Monitoring and Follow-up
- Evaluate clinical response within 48-72 hours of starting treatment
- If no improvement is seen within 3-5 days, consider:
- Obtaining bacterial culture and sensitivity testing
- Alternative diagnosis
- Possible need for different antibiotics or intravenous therapy 5
Side Effects and Considerations
- Common side effects include nausea (9%), diarrhea (9%), and rash (3%) 2
- Use with caution in patients with history of penicillin allergy
- Consider renal dosing adjustments in patients with impaired kidney function
By following these guidelines, Augmentin can be effectively used to treat minor skin infections, particularly when beta-lactamase producing organisms are suspected or confirmed.