Recommended Amoxicillin-Clavulanate Dosing for Non-Purulent Cellulitis

For adults with non-purulent cellulitis, amoxicillin-clavulanate should be administered at a dose of 875/125 mg twice daily for 5-10 days. 1

Dosing Recommendations

The Infectious Diseases Society of America specifically recommends amoxicillin-clavulanate 875/125 mg twice daily for adults with non-purulent cellulitis requiring coverage against both streptococci and methicillin-susceptible Staphylococcus aureus (MSSA) 1
For more severe infections or those involving the respiratory tract, the FDA-approved dosing is 875 mg/125 mg every 12 hours 2
Treatment should be initiated for 5 days, with extension if the infection has not adequately improved within this timeframe 1
The medication should be taken at the start of a meal to minimize gastrointestinal intolerance and enhance absorption of clavulanate 2

Non-purulent cellulitis is primarily caused by beta-hemolytic streptococci, but empirical coverage for MSSA is recommended when systemic signs of infection are present 1
The 875/125 mg twice daily dosing provides appropriate coverage for both beta-hemolytic streptococci and MSSA 1
Alternative therapy should be considered for patients with risk factors for methicillin-resistant S. aureus (MRSA) 1

For patients with renal impairment:
- GFR <30 mL/min: Do not use the 875/125 mg dose 2
- GFR 10-30 mL/min: Use 500/125 mg or 250/125 mg every 12 hours based on infection severity 2
- GFR <10 mL/min: Use 500/125 mg or 250/125 mg every 24 hours based on infection severity 2
- Hemodialysis patients: Administer 500/125 mg or 250/125 mg every 24 hours with additional doses during and after dialysis 2

Elevation of the affected area and treatment of predisposing factors are important components of management 1
Systemic corticosteroids could be considered in non-diabetic adult patients to improve symptoms 1
For recurrent episodes of cellulitis, prophylactic antibiotics may be considered 1

Failing to distinguish between purulent and non-purulent cellulitis, which affects antibiotic selection 1
Using fluoroquinolones as first-line therapy should be avoided 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, which can lead to treatment failure or recurrence 1
Twice-daily dosing of amoxicillin-clavulanate has been shown to improve patient compliance compared to three-times-daily dosing while maintaining efficacy 3
The 875/125 mg formulation contains more amoxicillin relative to clavulanate compared to older formulations, which may improve the gastrointestinal side effect profile 3