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

Amoxicillin-Clavulanate Dosing for Non-Purulent Cellulitis

For non-purulent cellulitis, amoxicillin-clavulanate should be dosed at 875/125 mg twice daily for 5-10 days. 1

Dosing Recommendations

• For adults with non-purulent cellulitis requiring coverage against both streptococci and MSSA, amoxicillin-clavulanate 875/125 mg twice daily is the recommended regimen 1, 2
• Treatment duration should be 5 days initially, but extended if the infection has not improved within this time period 1
• Twice daily dosing of amoxicillin-clavulanate provides equivalent clinical efficacy with improved gastrointestinal tolerability compared to three times daily dosing 2
• For more severe infections or systemic toxicity, consider initial parenteral therapy or hospitalization 1

Pathogen Coverage Considerations

• Non-purulent cellulitis is primarily caused by beta-hemolytic streptococci, but empirical coverage for MSSA may be included when systemic signs of infection are present 1
• Amoxicillin-clavulanate provides appropriate coverage for both beta-hemolytic streptococci and methicillin-susceptible S. aureus 1
• For patients with risk factors for MRSA (penetrating trauma, evidence of MRSA elsewhere, nasal colonization, injection drug use, or SIRS), alternative therapy should be considered 1

Treatment Algorithm

1. Mild non-purulent cellulitis (no systemic signs):

   • Consider an antimicrobial agent active against streptococci only 1
   • If MSSA coverage desired: amoxicillin-clavulanate 875/125 mg twice daily for 5 days 1, 2

2. Moderate non-purulent cellulitis (with systemic signs):

   • Amoxicillin-clavulanate 875/125 mg twice daily for 5-10 days 1
   • Evaluate response at day 5; extend treatment if inadequate improvement 1

3. Severe non-purulent cellulitis:

   • Consider hospitalization and initial parenteral therapy 1
   • If outpatient management: amoxicillin-clavulanate 875/125 mg twice daily with close follow-up 1

Special Considerations

• Elevation of the affected area and treatment of predisposing factors (edema, underlying skin disorders) are important adjunctive measures 1
• For lower extremity cellulitis, carefully examine interdigital toe spaces for fissuring, scaling, or maceration that may harbor pathogens 1
• Systemic corticosteroids (prednisone 40 mg daily for 7 days) could be considered in non-diabetic adult patients with cellulitis to improve symptoms 1
• For recurrent episodes of cellulitis (3-4 episodes per year), prophylactic antibiotics may be considered 1

Common Pitfalls

• Failing to distinguish between purulent and non-purulent cellulitis, which impacts antibiotic selection 1
• Using fluoroquinolones as first-line therapy, which should be reserved when other agents cannot be used due to concerns about resistance development 1
• Inadequate duration of therapy or failure to reassess at day 5 for potential extension of treatment 1
• Not addressing underlying predisposing factors that may lead to treatment failure or recurrence 1