Does Augmentin Cover Cellulitis?
Yes, Augmentin (amoxicillin-clavulanate) is an appropriate and effective first-line antibiotic for typical cellulitis, providing coverage against both streptococci and methicillin-sensitive Staphylococcus aureus, including beta-lactamase-producing strains. 1
Evidence Supporting Augmentin for Cellulitis
The Infectious Diseases Society of America explicitly includes amoxicillin-clavulanate as one of the appropriate first-line options for typical cellulitis, alongside penicillin, dicloxacillin, cephalexin, and clindamycin. 1
Amoxicillin-clavulanate provides empirical coverage for both streptococci (the primary pathogen in most cellulitis cases) and S. aureus producing beta-lactamases without waiting for culture results. 1
A retrospective study of 59 hospitalized patients with erysipelas or bacterial cellulitis demonstrated that amoxicillin-clavulanate was associated with the shortest hospital stays and less frequent need to change antibiotics compared to cephalosporins or clindamycin. 2
Clinical trials from the 1980s showed 81-94% success rates for Augmentin in treating skin and soft tissue infections, including cellulitis, with minimal side effects. 3, 4
Standard Dosing and Duration
Dose: Augmentin 875/125 mg orally twice daily for uncomplicated cellulitis. 1
Duration: Treat for 5 days if clinical improvement occurs; extend only if symptoms have not improved within this timeframe. 1, 5
Traditional 7-14 day courses are no longer necessary for uncomplicated cases. 1
When Augmentin is Particularly Appropriate
Human or animal bite-associated cellulitis: Augmentin provides single-agent coverage for polymicrobial oral flora at 875/125 mg twice daily. 1, 5
Cellulitis with traumatic wounds: The clavulanic acid component protects amoxicillin from beta-lactamases produced by S. aureus. 1
Recent amoxicillin use: Augmentin should be considered preferentially in patients who recently used amoxicillin. 1
Cellulitis not responding to simple beta-lactams: The beta-lactamase inhibitor provides broader coverage. 1
Purulent drainage present: Augmentin covers mixed infections of penicillin-resistant staphylococci and Streptococcus pyogenes. 1, 3
Critical Limitation: MRSA Coverage
Augmentin does NOT cover MRSA. 1
MRSA is an unusual cause of typical cellulitis, and routine coverage is unnecessary. 1, 5
Consider adding MRSA coverage (clindamycin alone, or trimethoprim-sulfamethoxazole plus a beta-lactam) only when specific risk factors are present: 1
- Penetrating trauma or injection drug use
- Purulent drainage or exudate
- Evidence of MRSA infection elsewhere
- Known nasal MRSA colonization
- Systemic inflammatory response syndrome (SIRS)
Comparison to Other First-Line Agents
Augmentin has equivalent efficacy to cephalexin or dicloxacillin for typical cellulitis. 1, 5
The advantage of Augmentin is single-agent coverage for both streptococci and beta-lactamase-producing S. aureus without requiring combination therapy. 1
Beta-lactam monotherapy (including Augmentin) is successful in 96% of typical cellulitis cases. 5
Common Pitfalls to Avoid
Do not add trimethoprim-sulfamethoxazole to Augmentin for bite-related cellulitis—Augmentin alone provides adequate polymicrobial coverage. 5
Do not routinely add MRSA coverage to Augmentin for typical nonpurulent cellulitis without specific risk factors. 1, 5
Do not extend treatment beyond 5 days automatically—only extend if clinical improvement has not occurred. 1, 5
Do not use Augmentin alone for purulent cellulitis requiring MRSA coverage—switch to clindamycin monotherapy or add a MRSA-active agent. 1
Essential Adjunctive Measures
Elevate the affected extremity to promote gravity drainage of edema and inflammatory substances. 1, 5
Examine interdigital toe spaces for tinea pedis, fissuring, scaling, or maceration, and treat these predisposing conditions. 1, 5
Address underlying venous insufficiency, lymphedema, eczema, or obesity to reduce recurrence risk. 1, 5