Can Amoxicillin-Clavulanate Be Used for Skin Infections?
Yes, amoxicillin-clavulanate (Amoxyclav) is an appropriate and guideline-recommended antibiotic for several types of skin and soft tissue infections, particularly impetigo, animal and human bites, and mixed aerobic-anaerobic infections. 1
Specific Indications Where Amoxicillin-Clavulanate Is Recommended
Impetigo
- Amoxicillin-clavulanate is explicitly recommended by the Infectious Diseases Society of America (IDSA) for treating impetigo in both pediatric and adult patients. 1
- The standard oral dosing is 875/125 mg twice daily for adults, or 25 mg/kg/day of the amoxicillin component in 2 divided doses for children. 1
- This covers both Staphylococcus aureus and Streptococcus pyogenes, the two primary pathogens in impetigo. 2
Animal and Human Bites
- Amoxicillin-clavulanate is the first-line oral agent for both animal and human bite wounds. 1
- For animal bites: 875/125 mg twice daily orally is recommended, providing coverage against Pasteurella multocida, streptococci, staphylococci, and anaerobes. 1
- For human bites: The same dosing applies, covering Eikenella corrodens, streptococci, S. aureus, and multiple anaerobes (Fusobacterium, Prevotella, Porphyromonas). 1
- Important caveat: Amoxicillin-clavulanate misses MRSA coverage, so if MRSA is suspected or documented, alternative agents are needed. 1
Diabetic Wound Infections
- For mild diabetic foot infections, amoxicillin-clavulanate is listed among recommended oral options. 1
- This provides broad coverage for the mixed aerobic and anaerobic flora commonly found in diabetic wounds. 1
General Cellulitis and Mixed Infections
- Amoxicillin-clavulanate is recommended for cellulitis when both staphylococcal and streptococcal coverage is needed. 2
- The IDSA guidelines specifically list it as an option for non-purulent skin and soft tissue infections. 1
- Dosing: 875/125 mg twice daily for adults, with treatment duration of 5 days if clinical improvement occurs by day 5, or 7-14 days for more severe infections. 2
When NOT to Use Amoxicillin-Clavulanate
MRSA Infections
- Do not use amoxicillin-clavulanate for purulent skin infections where MRSA is likely or confirmed. 1
- MRSA coverage requires vancomycin, linezolid, daptomycin, ceftaroline, clindamycin (if susceptible), doxycycline, or trimethoprim-sulfamethoxazole. 1
- Consider MRSA when there is purulent drainage, penetrating trauma, or concurrent MRSA infection elsewhere. 2
Simple Cellulitis Without Mixed Flora
- For typical non-purulent cellulitis caused by streptococci alone, penicillin or first-generation cephalosporins (cephalexin, cefazolin) are preferred as they are narrower spectrum. 2
- Reserve amoxicillin-clavulanate for situations where mixed infection is suspected or when broader coverage is needed. 1
Clinical Evidence Supporting Use
- Multiple clinical trials demonstrate amoxicillin-clavulanate is effective for skin and soft tissue infections, with cure rates of 72-79% in comparative studies. 3
- The addition of clavulanic acid overcomes beta-lactamase resistance, making it superior to amoxicillin alone for infections caused by beta-lactamase-producing S. aureus. 4, 5, 6
- In veterinary and human studies, clavulanate-potentiated amoxicillin showed significantly faster lesion resolution and higher success rates compared to amoxicillin alone, especially when resistant organisms were isolated. 5
Common Pitfalls to Avoid
- Do not assume amoxicillin-clavulanate covers MRSA—this is the most critical limitation. 1
- Some gram-negative rods may be resistant; if Pseudomonas is suspected, choose a different agent. 1
- Gastrointestinal side effects (diarrhea, nausea) occur in 9-21% of patients; taking with food may reduce these symptoms. 3, 4, 7
- For necrotizing fasciitis or severe polymicrobial infections, broader coverage with vancomycin plus piperacillin-tazobactam or a carbapenem is required. 1