Recommended Dose of Augmentin (Amoxicillin-Clavulanate) for Diabetic Foot Infection
For a diabetic patient with a possible skin infection on the lower limb, the recommended dose of Augmentin is 875 mg/125 mg orally twice daily for mild infections, taken at the start of meals to enhance absorption and minimize gastrointestinal side effects. 1
Infection Severity Classification First
Before prescribing, you must classify the infection severity based on clinical signs 2:
- Mild infection: Only skin and subcutaneous tissue involved, with local inflammation (erythema, warmth, swelling, tenderness) extending <2 cm around the wound 2
- Moderate infection: Deeper tissues involved or cellulitis extending >2 cm, but no systemic signs 2
- Severe infection: Systemic toxicity present (fever, hypotension, confusion) or metabolic instability 2
Dosing by Infection Severity
For Mild Infections
Amoxicillin-clavulanate 875 mg/125 mg orally twice daily is the first-line choice for mild diabetic foot infections. 2, 3 The FDA label specifies this dose for more severe infections and respiratory tract infections, which applies to infected diabetic foot wounds 1. Treatment duration should be 1-2 weeks based on clinical response 2, 3.
Alternative dosing is 500 mg/125 mg three times daily, but the twice-daily regimen is preferred for compliance 1.
For Moderate Infections
If the infection is moderate, oral amoxicillin-clavulanate 875 mg/125 mg twice daily can still be used, but consider adding a fluoroquinolone (levofloxacin 750 mg daily or ciprofloxacin) for broader gram-negative coverage 2, 3. Alternatively, switch to IV ampicillin-sulbactam 3 g every 6 hours if hospitalization is required 2. Treatment duration is 2-3 weeks 2.
For Severe Infections
Severe infections require initial IV therapy with piperacillin-tazobactam 4.5 g every 6 hours plus vancomycin 15-20 mg/kg every 8-12 hours, not oral amoxicillin-clavulanate 2, 3. Duration is 2-4 weeks depending on clinical response 2.
Critical Dosing Details from FDA Label
- Take at the start of meals to enhance clavulanate absorption and reduce GI intolerance 1
- Do NOT substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet, as both contain the same amount of clavulanic acid (125 mg), making them non-equivalent 1
- Do NOT substitute 250 mg/125 mg tablets for 250 mg/62.5 mg chewable tablets, as they contain different amounts of clavulanic acid 1
When to Add MRSA Coverage
Empirically add MRSA coverage (linezolid, daptomycin, or trimethoprim-sulfamethoxazole) to amoxicillin-clavulanate if 2, 3:
- Local MRSA rates exceed 50% for mild infections or 30% for moderate infections
- Prior inappropriate antibiotic use
- Recent hospitalization
- Chronic wounds or osteomyelitis present
- Male gender
Monitoring and Duration
Evaluate clinical response every 2-5 days for outpatients or daily for inpatients 2, 3. Primary indicators of improvement include resolution of erythema, warmth, swelling, purulent drainage, and systemic symptoms 2, 3.
Stop antibiotics when infection signs resolve, NOT when the wound fully heals. 3 Continuing antibiotics until complete wound closure increases antibiotic resistance without evidence of benefit 3.
Common Pitfalls to Avoid
- Do not treat clinically uninfected ulcers with antibiotics 3—only prescribe if at least 2 signs of inflammation are present 4, 2
- Do not use unnecessarily broad empiric coverage for mild infections 3—most mild infections are caused by gram-positive cocci and respond to amoxicillin-clavulanate alone 4, 2
- Ensure adequate surgical debridement 4, 3—antibiotics alone are often insufficient without removal of necrotic tissue 4
- Obtain deep tissue cultures via biopsy or curettage after debridement (not swabs) before starting antibiotics, then narrow therapy based on results 3