Augmentin for Cellulitis
Augmentin (amoxicillin-clavulanate) is an appropriate and effective first-line antibiotic option for typical cellulitis, providing coverage against both streptococci and beta-lactamase-producing Staphylococcus aureus. 1
Position in Treatment Guidelines
The Infectious Diseases Society of America (IDSA) explicitly includes amoxicillin-clavulanate as one of the appropriate first-line options for typical cellulitis, alongside penicillinase-resistant penicillins (dicloxacillin) and first-generation cephalosporins (cephalexin). 1
The clavulanic acid component protects amoxicillin from destruction by beta-lactamases produced by Staphylococcus aureus, allowing effective coverage against both streptococci and staphylococci in mixed skin and soft tissue infections. 1
Clinical Evidence Supporting Use
In hospitalized patients with erysipelas or bacterial cellulitis, amoxicillin-clavulanate was associated with the shortest hospital stays and was least frequently associated with the need to change antibiotics compared to cephalosporins or clindamycin. 2
Clinical studies demonstrate 81-94% success rates for Augmentin in treating skin and soft tissue infections, including cellulitis caused by amoxicillin-resistant Staphylococcus aureus. 3, 4
When to Preferentially Choose Augmentin
Consider amoxicillin-clavulanate as the preferred first-line agent in these specific scenarios:
- Recent amoxicillin use - where beta-lactamase-producing organisms are more likely 1
- Cellulitis associated with traumatic wounds - where mixed flora including S. aureus is common 1
- Infections not responding to simple beta-lactams - suggesting beta-lactamase production 1
- Cellulitis with purulent drainage - though this may also warrant MRSA coverage consideration 1
Treatment Duration
- Treat for 5 days if clinical improvement is evident - this is as effective as 10-day courses for uncomplicated cellulitis. 1
- Extend treatment beyond 5 days only if the infection has not improved in this period. 1
When Augmentin Is NOT Sufficient
MRSA is an unusual cause of typical cellulitis and Augmentin does not provide MRSA coverage. Add MRSA-active agents (clindamycin alone, or TMP-SMX plus a beta-lactam) when these specific risk factors are present: 1
- Penetrating trauma or injection drug use
- Purulent drainage or exudate visible
- Evidence of MRSA infection elsewhere or known nasal colonization
- Systemic inflammatory response syndrome (SIRS) criteria present
- Failure to respond to beta-lactam therapy after 24-48 hours
Safety Profile
- Side effects are generally mild, limited to nausea (9%), diarrhea (9%), and rash (3%). 3
- Dosage adjustment is required in severe renal impairment (GFR <30 mL/min) as amoxicillin is primarily eliminated by the kidney. 5
- The drug is well tolerated even at relatively high doses. 6
Critical Pitfall to Avoid
Do not routinely add MRSA coverage for typical cellulitis when using Augmentin. Reserve MRSA-active agents only for the specific high-risk scenarios listed above, as MRSA is an unusual cause of typical cellulitis and routine coverage is unnecessary. 1