Can Augmentin (amoxicillin/clavulanate) be used to treat cellulitis and urinary tract infections (UTIs)?

Can Augmentin Cover for Cellulitis and UTI?

Yes, Augmentin (amoxicillin-clavulanate) is an appropriate antibiotic for both cellulitis and urinary tract infections, as it is explicitly recommended in major guidelines for both conditions.

Cellulitis Coverage

Augmentin is specifically listed as a suitable oral antibiotic for typical cellulitis cases. 1

• The IDSA guidelines recommend antibiotics active against streptococci for typical cellulitis, and explicitly name amoxicillin-clavulanate as one of the appropriate choices alongside penicillin, amoxicillin, dicloxacillin, cephalexin, or clindamycin 1
• For uncomplicated cellulitis, a 5-day course is as effective as a 10-day course if clinical improvement has occurred by 5 days 1
• MRSA coverage is usually unnecessary for typical cellulitis, as β-lactams like cefazolin or oxacillin were successful in 96% of patients in prospective studies 1

When to Consider Additional MRSA Coverage

You should add MRSA coverage (and potentially avoid Augmentin monotherapy) in these specific scenarios:

• Cellulitis associated with penetrating trauma, especially from illicit drug use 1
• Presence of purulent drainage 1
• Concurrent evidence of MRSA infection elsewhere 1
• Nasal colonization with MRSA 1

UTI Coverage

Augmentin is FDA-approved for urinary tract infections caused by beta-lactamase-producing E. coli, Klebsiella species, and Enterobacter species. 2

Uncomplicated UTI

• Augmentin can be used for uncomplicated cystitis, though it is not typically a first-line agent 3
• First-line agents remain fosfomycin, nitrofurantoin, and pivmecillinam per European Association of Urology guidelines 3
• Clinical trials demonstrate cure rates of approximately 70% for amoxicillin-resistant organisms when treated with Augmentin 4

Complicated UTI and Pyelonephritis

• For complicated UTIs with systemic symptoms, Augmentin is not the preferred agent 5
• Guidelines recommend second-generation cephalosporins plus an aminoglycoside, or third-generation cephalosporins (ceftriaxone 1-2g daily or cefotaxime 2g three times daily) for complicated UTIs 5
• Clinical trial data show Augmentin 875/125 mg every 12 hours produced comparable bacteriological success rates to the every-8-hour regimen in pyelonephritis and complicated UTIs 2
• Treatment duration for complicated UTIs should be 7-14 days depending on clinical response 5

Recurrent UTI

• For recurrent UTIs, Augmentin 250/125 mg every 8 hours for 7 days achieved 84% microbiological cure rates at 1 week post-treatment and 67% at 1 month 6

Dosing Recommendations

For cellulitis: Standard adult dosing is 875/125 mg twice daily or 500/125 mg three times daily for 5 days 1, 2

For UTI:

• Uncomplicated: 875/125 mg twice daily 2
• Complicated: 875/125 mg twice daily for 7-14 days 2

Important Caveats

• Always obtain urine culture before starting antibiotics for complicated UTIs due to high likelihood of resistance 5
• Augmentin should not be used when susceptibility testing shows the organism is susceptible to amoxicillin alone (indicating no beta-lactamase production) 2
• The drug is well-tolerated, though diarrhea occurs in approximately 15% of patients 2
• For pyelonephritis in infants and young children, cephalexin (and by extension, likely Augmentin) is not recommended due to inadequate therapeutic bloodstream concentrations 3