What is the recommended dosage 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 uncommon and streptococci are the primary pathogens. 1

When Augmentin IS Appropriate

Augmentin 875/125 mg orally twice daily is specifically indicated for cellulitis associated with human or animal bites, where coverage of Pasteurella species and mixed oral flora is needed. 1 This provides single-agent coverage for both streptococci and common skin flora in bite-related infections. 1

Standard Dosing When Used

• Augmentin 875/125 mg orally twice daily for 5 days if clinical improvement occurs 1
• Extend treatment beyond 5 days ONLY if the infection has not improved within this initial period 1
• Traditional 7-14 day courses are no longer necessary for uncomplicated cases 1

Critical Decision Points: When NOT to Use Augmentin

Augmentin lacks anti-MRSA activity and should NOT be used for purulent cellulitis requiring MRSA coverage. 1 In these situations, use doxycycline plus a beta-lactam or clindamycin monotherapy instead. 1

Specific scenarios where Augmentin is insufficient:

• Penetrating trauma or injection drug use 1
• Known MRSA colonization 1
• Purulent drainage or exudate present 1
• Cellulitis with systemic inflammatory response syndrome (SIRS) 1

Why Beta-Lactam Monotherapy is Preferred for Typical Cellulitis

Beta-lactam treatment is successful in 96% of patients with typical cellulitis, confirming that broader coverage with Augmentin is usually unnecessary. 1 The clavulanate component adds cost and gastrointestinal side effects without improving outcomes in standard cellulitis. 2

Preferred oral agents for typical nonpurulent cellulitis include:

• Cephalexin 500 mg four times daily 3
• Dicloxacillin 250-500 mg every 6 hours 1
• Penicillin 1
• Clindamycin (provides both streptococcal and MRSA coverage if needed) 1

Common Pitfalls to Avoid

• Don't reflexively add MRSA coverage or use broader agents like Augmentin for typical nonpurulent cellulitis without specific risk factors 1
• Don't extend treatment beyond 5 days if clinical improvement has occurred—this is as effective as 10-day courses 1
• Don't forget to assess for abscess with ultrasound if there is clinical uncertainty, as purulent collections require incision and drainage plus MRSA-active antibiotics 1

Adjunctive Measures

• Elevate the affected extremity to promote drainage and hasten improvement 2, 1
• Examine interdigital toe spaces for tinea pedis and treat toe web abnormalities to reduce recurrence risk 1
• Address predisposing conditions including edema, venous insufficiency, and lymphedema 1