Can a healthcare provider prescribe Augmentin (amoxicillin/clavulanate) for a skin infection and what is the recommended dose?

Augmentin for Skin Infections: Prescribing and Dosing

Yes, healthcare providers can prescribe Augmentin (amoxicillin-clavulanate) for skin infections, and the standard adult dose is 875 mg/125 mg orally every 12 hours for more severe infections or 500 mg/125 mg every 8-12 hours for less severe infections. 1

When to Prescribe Augmentin for Skin Infections

Primary Indications

• Human bite wounds are the clearest indication for Augmentin, as the drug provides coverage against Eikenella corrodens, streptococci, S. aureus, and multiple anaerobic organisms that commonly cause these infections 2
• Animal bite wounds also warrant Augmentin therapy, with dosing at 875 mg/125 mg twice daily orally 2
• Mixed infections involving both aerobic and anaerobic bacteria benefit from Augmentin's broad spectrum coverage 3, 4

Secondary Considerations

• Augmentin is particularly valuable when beta-lactamase-producing organisms are suspected, as clavulanic acid inhibits these enzymes and restores amoxicillin activity 3
• For infected eczema, infected trauma wounds, and leg ulcers, Augmentin demonstrated 94% response rates in clinical studies 3
• When amoxicillin-resistant Staphylococcus aureus is present (but not MRSA), Augmentin provides effective coverage 3

Dosing Recommendations

Adults

For more severe skin and soft tissue infections:

• 875 mg/125 mg orally every 12 hours 1
• This is the preferred regimen for respiratory tract infections and more severe skin infections 1

For less severe infections:

• 500 mg/125 mg every 12 hours OR 250 mg/125 mg every 8 hours 1
• The every 12-hour regimen is associated with significantly less diarrhea 1

Administration:

• Take at the start of meals to enhance clavulanate absorption and minimize gastrointestinal intolerance 1

Pediatric Patients (≥12 weeks/3 months)

For more severe infections:

• 45 mg/kg/day (based on amoxicillin component) divided every 12 hours using the 200 mg/5 mL or 400 mg/5 mL suspension 1

For less severe infections:

• 25 mg/kg/day divided every 12 hours 1

Children ≥40 kg:

• Dose according to adult recommendations 1

Critical Pitfalls to Avoid

Formulation Errors

• Never substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet - they contain the same amount of clavulanic acid (125 mg), making them non-equivalent 1
• Different formulations contain different ratios of amoxicillin to clavulanic acid and are not interchangeable 1

MRSA Coverage

• Augmentin does NOT cover MRSA 2
• For purulent infections with suspected MRSA (history of MRSA, injection drug use, failed initial therapy, or systemic signs), choose alternative agents like trimethoprim-sulfamethoxazole, doxycycline, or clindamycin instead 2

Storage and Compliance

• In hot climates, improper storage (such as leaving medication in a hot car) can degrade the antibiotic and lead to treatment failure 5
• Counsel patients on proper storage and the importance of completing the full course 5

Expected Outcomes and Monitoring

Efficacy

• Clinical success rates of 96-97% for skin and soft tissue infections have been demonstrated in hospitalized patients 4
• Bacteriologic cure rates of 72-76% are typical 6

Adverse Effects

• Diarrhea (3.6-9%) and nausea (9%) are the most common side effects 3, 4
• Skin reactions (3-4.8%) may occur 3, 4
• The every 12-hour dosing regimen significantly reduces diarrhea compared to every 8-hour dosing 1

Duration of Therapy

• Typical duration is 7-10 days depending on clinical response 2
• Clinical improvement should be evident within 48-72 hours of initiating therapy 7