Augmentin for Cellulitis Treatment
Augmentin (amoxicillin-clavulanate) is an effective first-line treatment option for typical cellulitis, particularly when oral therapy is appropriate and MRSA is not suspected. 1, 2
Pathogen Coverage and Efficacy
Cellulitis is most commonly caused by streptococci (particularly group A streptococcus), followed by Staphylococcus aureus 1, 2
Augmentin provides excellent coverage against:
A 2019 study demonstrated that amoxicillin-clavulanate was associated with the shortest hospital stay for patients with erysipelas or bacterial cellulitis compared to other antibiotics like cephalosporins or clindamycin 3
Treatment Recommendations
For Typical Non-Purulent Cellulitis:
- Augmentin 875/125 mg orally twice daily is recommended as a first-line option 2
- Treatment duration: 5 days is sufficient for uncomplicated cellulitis if clinical improvement occurs within this timeframe 1, 2
- For more severe cases, treatment may be extended if the infection has not improved within 5 days 1
When to Consider Alternative Antibiotics:
- MRSA Considerations: If MRSA is suspected (history of MRSA, injection drug use, purulent drainage, or systemic inflammatory response syndrome), alternative antibiotics like vancomycin, linezolid, or clindamycin should be considered 1, 2
- Penicillin Allergy: Clindamycin 300-450 mg orally three times daily is recommended 2
Adjunctive Measures
- Elevation of the affected area is crucial to promote drainage of edema and inflammatory substances 1, 2
- Examine and treat predisposing conditions:
Clinical Pearls and Pitfalls
Pearls:
- Augmentin provides broader coverage than amoxicillin alone due to the beta-lactamase inhibitor (clavulanic acid), making it effective against many resistant strains 4, 5
- Combination therapy with amoxicillin-clavulanate has been shown to require fewer antibiotic changes during treatment courses 3
Pitfalls to Avoid:
- Overuse of broad-spectrum antibiotics: For typical non-purulent cellulitis, adding trimethoprim-sulfamethoxazole to beta-lactams does not improve outcomes 2
- Unnecessary MRSA coverage: MRSA is an unusual cause of typical cellulitis; treatment for MRSA is usually unnecessary unless specific risk factors are present 1, 2
- Inadequate duration: While 5 days is sufficient for uncomplicated cases, treatment should be extended if improvement is not seen 1
- Failure to elevate the affected area, which is crucial for reducing edema and promoting healing 2
Monitoring and Follow-up
- Monitor daily until improvement is observed
- Consider hospitalization if:
Augmentin has demonstrated high efficacy in treating skin infections with minimal side effects, making it a valuable option for cellulitis treatment in both outpatient and inpatient settings 4, 6, 3.