What is the recommended dose of Augmentin (amoxicillin-clavulanate) for treating cellulitis?

Augmentin Dosing for Cellulitis

For typical uncomplicated cellulitis, Augmentin is NOT the preferred first-line agent—beta-lactam monotherapy with cephalexin, dicloxacillin, or penicillin is recommended instead, as MRSA is an uncommon cause and Augmentin provides unnecessarily broad coverage. 1

When Augmentin IS Appropriate

Augmentin has specific indications where it becomes the agent of choice:

• Human or animal bite-associated cellulitis: Augmentin 875/125 mg orally twice daily provides single-agent coverage for both streptococci and common oral flora from bite wounds 1
• Duration: 5 days if clinical improvement occurs, extending only if symptoms have not improved within this timeframe 2, 1

Standard Dosing Regimens

Adults and Pediatric Patients ≥40 kg

• Mild to moderate skin/skin structure infections: 500 mg every 12 hours OR 250 mg every 8 hours 3
• Severe infections: 875 mg every 12 hours OR 500 mg every 8 hours 3
• Take at the start of a meal to minimize gastrointestinal intolerance 3

Pediatric Patients <40 kg and ≥3 Months

• Mild to moderate: 25 mg/kg/day divided every 12 hours OR 20 mg/kg/day divided every 8 hours 3
• Severe infections: 45 mg/kg/day divided every 12 hours OR 40 mg/kg/day divided every 8 hours 3

Why Augmentin Is Usually NOT First-Line for Cellulitis

Beta-lactam monotherapy succeeds in 96% of typical cellulitis cases, confirming that the broader coverage provided by Augmentin is unnecessary. 1

• The Infectious Diseases Society of America recommends beta-lactam monotherapy (penicillin, amoxicillin, dicloxacillin, cephalexin, or clindamycin) as standard of care for uncomplicated cellulitis 1
• MRSA is an uncommon cause of typical nonpurulent cellulitis, making the clavulanate component redundant 1
• Preferred oral agents include cephalexin 500 mg four times daily or dicloxacillin at equivalent dosing 1, 4

Critical Decision Points

Use Augmentin When:

• Cellulitis results from human or animal bites (dose: 875/125 mg twice daily) 1
• Patient requires single-agent coverage for mixed aerobic/anaerobic flora 1

Do NOT Use Augmentin When:

• Typical nonpurulent cellulitis without bite history—use cephalexin or dicloxacillin instead 1, 4
• Purulent cellulitis requiring MRSA coverage—Augmentin lacks anti-MRSA activity; use doxycycline plus a beta-lactam or clindamycin monotherapy 2, 1
• Penetrating trauma, injection drug use, or known MRSA colonization—these require specific MRSA-active agents 2

Renal Dosing Adjustments

• GFR 10-30 mL/min: 500 mg or 250 mg every 12 hours 3
• GFR <10 mL/min: 500 mg or 250 mg every 24 hours 3
• Hemodialysis: 500 mg or 250 mg every 24 hours, with additional dose during and at end of dialysis 3
• Do NOT use the 875 mg dose in patients with GFR <30 mL/min 3

Common Pitfalls to Avoid

• Don't reflexively prescribe Augmentin for all cellulitis—it represents overtreatment for typical cases where narrower-spectrum agents are equally effective 1
• Don't extend treatment beyond 5 days if clinical improvement has occurred—traditional 7-14 day courses are no longer necessary 2, 1
• Don't use Augmentin for MRSA coverage—it has no activity against methicillin-resistant organisms and requires combination with TMP-SMX or doxycycline if MRSA is suspected 2, 1
• Don't forget to assess for bite history—this is the primary indication where Augmentin becomes first-line 1

Adjunctive Measures

• Elevate the affected extremity to promote drainage 1
• Treat predisposing conditions including tinea pedis, venous insufficiency, lymphedema, and toe web abnormalities 1
• Consider systemic corticosteroids (prednisone 40 mg daily for 7 days) in non-diabetic adults, though evidence is limited 1