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

Recommended Dosage of Augmentin for Cellulitis

For treating cellulitis in adults, the recommended dose of Augmentin (amoxicillin-clavulanate) is 875/125 mg taken orally twice daily for 5-6 days. 1, 2

Dosing Recommendations

Adults:

• First-line dose: 875/125 mg twice daily orally 1
• Duration: 5-6 days for uncomplicated cases 1, 2
• Extension: Consider extending treatment if infection has not improved after 5 days 1

Children:

• Recommended dose: 25 mg/kg/day of the amoxicillin component in 2 divided doses orally 1
• Duration: 5-6 days for uncomplicated cases 1, 2

Evidence Supporting Shorter Treatment Duration

Recent guidelines from the American College of Physicians (2021) and the Infectious Diseases Society of America recommend shorter courses of antibiotics for cellulitis:

• 5-6 day courses are as effective as longer courses for uncomplicated cellulitis 1, 2
• Longer courses have not demonstrated superior outcomes but increase risk of adverse effects and antimicrobial resistance 2
• Treatment should be reassessed after 5 days and extended only if inadequate improvement is seen 1, 2

Efficacy of Amoxicillin-Clavulanate for Cellulitis

Amoxicillin-clavulanate is particularly effective for cellulitis because:

• It provides coverage against both beta-hemolytic streptococci (primary cause) and beta-lactamase-producing organisms 1, 2
• Studies show it is associated with shorter hospital stays compared to cephalosporins or clindamycin 3
• The clavulanic acid component inhibits beta-lactamases, reducing resistance and enhancing efficacy 4

Special Considerations

When to Consider Alternative Antibiotics:

• MRSA risk factors: For cellulitis associated with penetrating trauma, evidence of MRSA infection elsewhere, nasal colonization with MRSA, injection drug use, or systemic inflammatory response syndrome 1, 2
• Alternative options when MRSA is suspected:
  • Clindamycin: 300-450 mg three times daily orally 1, 2
  • Trimethoprim-sulfamethoxazole: 1-2 double-strength tablets twice daily (but caution as it has poor activity against streptococci when used alone) 1, 2, 5
  • Linezolid: 600 mg twice daily 2

Monitoring and Follow-up:

• Assess for clinical improvement within 48-72 hours
• Extend treatment if inadequate improvement after 5 days 1, 2
• Consider intravenous therapy if oral treatment fails or for severe infections 1, 2

Practical Tips

• Elevate the affected area to reduce edema 2
• Consider warm compresses to improve circulation and antibiotic delivery 2
• Address underlying conditions (edema, venous insufficiency, interdigital toe space abnormalities) to prevent recurrence 2
• Avoid unnecessary prolonged courses of antibiotics when shorter durations are equally effective 2

Amoxicillin-clavulanate remains a first-line agent for cellulitis due to its broad spectrum of activity against the most common causative organisms and favorable clinical outcomes 4, 3.