What is the standard dose and duration of Augmentin (amoxicillin-clavulanate) for treating cellulitis?

Standard Dose and Duration of Augmentin for Cellulitis

For typical cellulitis, Augmentin (amoxicillin-clavulanate) is an appropriate first-line oral antibiotic, and the standard treatment duration is 5 days, with extension only if clinical improvement has not occurred by that time. 1

Dosing Recommendations

While the IDSA guidelines list amoxicillin-clavulanate as a suitable option for cellulitis without specifying exact dosing, standard adult dosing for skin and soft tissue infections is:

• Augmentin 875 mg/125 mg orally twice daily, or
• Augmentin 500 mg/125 mg orally three times daily

These are the typical formulations used for moderate skin infections in clinical practice.

Treatment Duration

The recommended duration is 5 days for uncomplicated cellulitis. 1, 2 This represents a significant departure from older practices:

• Treatment should be extended beyond 5 days only if the infection has not improved within this timeframe (strong recommendation, high-quality evidence). 1
• Multiple guidelines support 5-6 day courses as equally effective as longer durations. 2, 3
• There is no evidence supporting treatment durations longer than 5 days for typical cases. 3

Clinical Context and Antibiotic Selection

Augmentin provides appropriate coverage for the primary pathogens in cellulitis:

• Beta-hemolytic streptococci are the predominant cause of typical cellulitis. 1, 2
• The amoxicillin component targets streptococci effectively. 1, 2
• The clavulanate extends coverage to include methicillin-susceptible Staphylococcus aureus (MSSA). 1

MRSA coverage is typically NOT needed for typical cellulitis. 1 Beta-lactam monotherapy (including Augmentin) is successful in 96% of cellulitis cases. 1 Consider adding MRSA coverage only with specific risk factors: penetrating trauma, injection drug use, purulent drainage, or concurrent MRSA infection elsewhere. 1, 2

Essential Adjunctive Measures

Beyond antibiotics, these interventions are critical:

• Elevate the affected extremity to promote drainage of edema and inflammatory mediators. 1, 2
• Examine interdigital toe spaces for fissuring, scaling, or maceration that harbors pathogens—treating these reduces recurrence. 1, 2
• Address predisposing conditions such as edema, venous insufficiency, or tinea pedis. 1, 2

When to Extend or Escalate Therapy

Extend treatment beyond 5 days if:

• Clinical improvement has not occurred by day 5 (fever persists, erythema continues to spread, or systemic symptoms worsen). 1

Consider hospitalization and IV antibiotics for:

• Signs of systemic inflammatory response syndrome (SIRS), altered mental status, or hemodynamic instability. 1
• Concern for deeper infection or necrotizing fasciitis. 1
• Failure of outpatient therapy. 1

Common Pitfalls to Avoid

• Prescribing 10-14 day courses reflexively—this is outdated practice not supported by evidence. 3
• Failing to elevate the affected area—this simple measure significantly hastens resolution. 2
• Not examining toe webs in lower extremity cellulitis—untreated tinea pedis is a major source of recurrent infection. 1, 2
• Adding MRSA coverage unnecessarily—typical cellulitis without purulence or specific risk factors does not require anti-MRSA therapy. 1, 2