Can Augmentin (amoxicillin-clavulanate) be given for a suspected skin infection?

Can Augmentin Be Given for a Suspected Skin Infection?

Yes, Augmentin (amoxicillin-clavulanate) is an appropriate and FDA-approved antibiotic for suspected skin infections, particularly when beta-lactamase-producing bacteria such as Staphylococcus aureus are likely pathogens. 1

FDA-Approved Indication

• Augmentin is specifically FDA-approved for skin and skin structure infections caused by beta-lactamase-producing isolates of Staphylococcus aureus, Escherichia coli, and Klebsiella species 1
• The drug combines amoxicillin with clavulanate (a beta-lactamase inhibitor), making it effective against organisms that would otherwise be resistant to amoxicillin alone 1

When to Use Augmentin for Skin Infections

For non-purulent infections (cellulitis):

• First-line options recommended by the Infectious Diseases Society of America include cephalexin or dicloxacillin for uncomplicated cellulitis 2
• However, Augmentin is an appropriate alternative, particularly when mixed infections or beta-lactamase-producing organisms are suspected 3

For bite wounds (animal or human):

• Augmentin is specifically recommended as the antibiotic of choice because bite wounds typically involve mixed aerobic and anaerobic bacteria from oral flora, including Pasteurella species, Staphylococcus, Streptococcus, and anaerobes 3
• The combination provides coverage against both aerobic and anaerobic pathogens commonly found in these infections 3

For infections in damaged skin:

• When systemic signs of infection are present, compromised immune status exists, or severe cellulitis accompanies wounds, broad-spectrum coverage effective against aerobic and anaerobic organisms is required 3
• Augmentin fits this profile as it covers both aerobic and anaerobic bacteria 3

Dosing

• Standard adult dosing: 500-875 mg twice daily or 500 mg three times daily, depending on infection severity 1
• Treatment duration: 5-7 days for most uncomplicated skin infections if clinical improvement occurs 2, 4

Clinical Evidence Supporting Use

• Studies demonstrate 81-94% success rates for Augmentin in treating various skin infections including primary skin sepsis, infected eczema, infected trauma, and mixed infections involving penicillin-resistant staphylococci and streptococci 5, 6
• Augmentin is particularly valuable in mixed infections where beta-lactamase-producing S. aureus is present alongside Streptococcus pyogenes, as amoxicillin alone fails in this scenario 7

Important Caveats

When NOT to use Augmentin:

• If susceptibility testing shows the organism is susceptible to amoxicillin alone (indicating no beta-lactamase production), use amoxicillin instead—Augmentin should not be used 1
• For suspected MRSA infections (common in injection drug users, penetrating trauma, or known MRSA colonization), Augmentin is ineffective—use trimethoprim-sulfamethoxazole, doxycycline, clindamycin, or vancomycin instead 2, 4

For purulent infections (abscesses):

• Incision and drainage is the primary treatment; antibiotics like Augmentin are adjunctive only 2, 4
• If MRSA is suspected based on local epidemiology or risk factors, choose MRSA-active agents rather than Augmentin 2

Storage considerations:

• Augmentin degrades rapidly in hot temperatures; improper storage (such as leaving it in a hot car) renders it ineffective 8
• Patients must be counseled on proper storage, especially in hot climates 8

Common Pitfalls to Avoid

• Do not use Augmentin as monotherapy for suspected MRSA infections—it lacks activity against methicillin-resistant organisms 2, 4
• Do not treat simple abscesses with antibiotics alone without drainage 4
• Do not fail to obtain cultures before starting antibiotics when feasible, as this guides definitive therapy 4
• Do not continue antibiotics for the entire wound healing period—treat based on the infection biology (typically 5-7 days), not wound closure 3