What is the recommended dosage and duration of Augmentin (amoxicillin-clavulanate) for the treatment of paronychia?

Augmentin Dosage and Duration for Paronychia

For acute bacterial paronychia in adults, Augmentin (amoxicillin-clavulanate) should be dosed at 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours for 7-10 days. 1

Dosing Recommendations

Adults:

• For mild to moderate paronychia:

  • 500 mg/125 mg tablet every 12 hours 1
  • Take at the start of a meal to enhance absorption and minimize gastrointestinal intolerance 1

• For more severe infections:

  • 875 mg/125 mg tablet every 12 hours OR
  • 500 mg/125 mg tablet every 8 hours 1

Pediatric Patients:

• Patients weighing 40 kg or more: Follow adult recommendations 1
• Patients aged 12 weeks and older but less than 40 kg:
  • For more severe infections: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours 1
  • For less severe infections: 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours 1
• Neonates and infants under 12 weeks: 30 mg/kg/day divided every 12 hours 1

Patients with Renal Impairment:

• GFR 10-30 mL/min: 500 mg/125 mg or 250 mg/125 mg every 12 hours 1
• GFR <10 mL/min: 500 mg/125 mg or 250 mg/125 mg every 24 hours 1
• Patients on hemodialysis: 500 mg/125 mg or 250 mg/125 mg every 24 hours with additional doses during and at the end of dialysis 1
• Patients with GFR <30 mL/min should not receive the 875 mg/125 mg dose 1

Duration of Therapy

The typical duration for treating acute bacterial paronychia with Augmentin is 7-10 days, though this may need to be extended based on clinical response 2, 3.

Management Algorithm for Paronychia

Step 1: Assessment and Classification

• Determine if paronychia is acute or chronic (symptoms lasting ≥6 weeks) 2
• Assess for abscess formation, which would require drainage 2

Step 2: Initial Management

• For early or mild acute paronychia without abscess:
  • Warm soaks with or without Burow solution or 1% acetic acid 2
  • Topical antibiotics with or without topical steroids 2

Step 3: When to Use Oral Antibiotics (Augmentin)

• Presence of moderate to severe infection 2, 3
• Failed response to topical therapy 2
• Immunocompromised patients 2
• Evidence of spreading infection 2

Step 4: Drainage Procedures

• If abscess is present, drainage is mandatory before or concurrent with antibiotic therapy 2
• Options range from using a hypodermic needle to a wide incision with a scalpel 2

Important Considerations

• Bacterial cultures: Consider obtaining cultures before starting antibiotics, especially in severe cases or treatment failures 4
• Secondary fungal infections: Up to 25% of paronychia cases may have secondary fungal infections, which may require antifungal therapy if not responding to antibiotics 4
• Chronic paronychia: This is often non-infectious and represents an irritant dermatitis; antibiotics are generally not effective unless secondary infection is proven 5, 2

Common Pitfalls to Avoid

• Overuse of antibiotics: Systemic antibiotics are ineffective for chronic paronychia unless infection is proven 5
• Inadequate drainage: Failure to drain an abscess will result in treatment failure regardless of antibiotic therapy 2
• Overlooking underlying causes: In chronic cases, addressing the underlying cause (contact irritants, moisture exposure) is essential for successful treatment 2, 6
• Incorrect dosing in renal impairment: Patients with renal impairment require dose adjustments to prevent toxicity 1

Remember that paronychia is often polymicrobial, and Augmentin provides good coverage against common pathogens including Staphylococcus aureus and oral anaerobes that may be introduced through finger sucking or nail biting 2, 3.