Is Augmentin Effective Against Scalp Impetigo?
Yes, Augmentin (amoxicillin-clavulanate) is effective against impetigo, including scalp impetigo, and is specifically recommended as a first-line oral antibiotic option by the Infectious Diseases Society of America. 1
Guideline-Based Recommendations
The IDSA guidelines explicitly list amoxicillin-clavulanate as an appropriate oral antibiotic for impetigo treatment at a dose of 875/125 mg twice daily for adults or 25 mg/kg/day of the amoxicillin component in 2 divided doses for children. 1 This recommendation applies to all forms of impetigo, including scalp involvement, as the causative organisms (Staphylococcus aureus and Streptococcus pyogenes) are the same regardless of anatomic location. 1
Why Augmentin Works for Impetigo
Dual organism coverage: Impetigo is caused by both S. aureus and S. pyogenes, and Augmentin provides coverage against both pathogens. 1
Beta-lactamase inhibition: The clavulanic acid component overcomes penicillinase-producing staphylococci that would otherwise be resistant to amoxicillin alone. 2 A prospective double-blind study demonstrated that Augmentin achieved marked improvement in 71% of patients after 2 days and 95% after 5 days, compared to only 44% and 68% respectively with amoxicillin alone. 2
Proven clinical efficacy: Multiple studies confirm Augmentin's effectiveness against skin infections caused by amoxicillin-resistant S. aureus, with a 94% response rate in one series. 3
When to Use Oral vs Topical Therapy
Limited lesions: Start with topical mupirocin or retapamulin for patients with few lesions and no systemic symptoms. 4
Extensive disease or scalp involvement: Use oral antibiotics like Augmentin when lesions are numerous, widespread, or involve hair-bearing areas like the scalp where topical application is impractical. 4
Treatment failure: Switch to oral antibiotics if no improvement occurs after 3-5 days of topical therapy. 4
Important Caveats
MRSA consideration: In areas with high community-acquired MRSA prevalence, Augmentin may not provide adequate coverage, as MRSA strains are resistant to beta-lactam antibiotics. 1 If MRSA is suspected (treatment failure, known local prevalence, or positive culture), switch to clindamycin, trimethoprim-sulfamethoxazole, or doxycycline. 4
Resistance patterns: Some gram-negative rods may be resistant to Augmentin, and it does not cover MRSA. 1 However, these organisms are uncommon causes of impetigo.
Side effects: Monitor for gastrointestinal symptoms (nausea 9%, diarrhea 9%) and rash (3%), though these are generally mild. 3
Treatment Duration
Continue oral antibiotics for 5-10 days to ensure adequate treatment and prevent recurrence. 4