Is Augmentin (amoxicillin-clavulanate) effective for treating cellulitis of the toes?

Augmentin for Cellulitis of the Toes

Augmentin (amoxicillin-clavulanate) is an effective first-line treatment for cellulitis of the toes, particularly when mixed infections of streptococci and staphylococci are suspected. 1, 2

Pathogen Considerations

• Most cases of cellulitis are caused by beta-hemolytic streptococci (groups A, B, C, or G)
• Staphylococcus aureus is less common but important, especially with:
  • Previous penetrating trauma
  • Underlying abscess
  • Injection sites
• Toe web spaces often harbor streptococci that cause lower extremity infections 1

Treatment Algorithm

First-line Oral Therapy

• Augmentin (amoxicillin-clavulanate) is particularly effective for:
  • Mixed infections involving both streptococci and staphylococci
  • Cases where beta-lactamase producing organisms are suspected
  • Uncomplicated cellulitis of the toes 3, 2

Alternative Oral Options

• Dicloxacillin
• Cephalexin
• Clindamycin (especially if MRSA is suspected)
• TMP-SMX (if purulent and MRSA is suspected) 1, 4

For Severe Cases Requiring Parenteral Therapy

• Nafcillin
• Cefazolin
• Clindamycin or vancomycin (for penicillin allergies) 1

Treatment Duration

• 5 days of antibiotic treatment is as effective as 10 days for uncomplicated cellulitis 1, 5
• May extend to 7-14 days for complicated cases 4

Adjunctive Measures

1. Elevate the affected area to promote drainage of edema and inflammatory substances 1
2. Treat underlying conditions:
   • Tinea pedis (especially interdigital)
   • Venous eczema
   • Trauma sites 1
3. Consider systemic corticosteroids in select adult patients to hasten resolution (contraindicated in diabetics, pregnant women) 1, 6

Prevention of Recurrence

• Treat interdigital maceration
• Keep skin hydrated with emollients
• Reduce underlying edema through:
  • Elevation
  • Compression stockings
  • Diuretic therapy if appropriate 1
• For frequent recurrences, consider prophylactic antibiotics:
  • Monthly benzathine penicillin injections
  • Oral erythromycin or penicillin V 1

Clinical Pearls and Pitfalls

• Augmentin has shown a 94% response rate in skin infections, with particularly good results for mixed infections 2
• Common side effects include nausea (9%), diarrhea (9%), and rash (3%) 2
• Patients with chills on admission, chronic venous insufficiency, or anemia may require longer hospitalization 3
• If no improvement occurs within 48-72 hours, consider:
  • Deeper infection
  • Resistant organisms
  • Underlying conditions (diabetes, venous insufficiency, lymphedema) 1
• Failure to treat underlying tinea pedis may lead to recurrent infections 1

Augmentin's combination of amoxicillin with the beta-lactamase inhibitor clavulanic acid makes it particularly valuable for skin infections where mixed flora or resistant organisms may be present, making it an excellent choice for cellulitis of the toes 2.