Augmentin Duration for Cellulitis
For uncomplicated cellulitis, treat with Augmentin 875/125 mg twice daily for 5 days if clinical improvement occurs, extending only if symptoms have not improved within this timeframe. 1
Standard Dosing and Duration
- The recommended adult dose is Augmentin 875/125 mg orally every 12 hours for more severe infections and respiratory tract infections. 2
- The Infectious Diseases Society of America establishes 5 days as the standard treatment duration for cellulitis, with extension only if the infection has not improved within this initial period. 1
- A landmark randomized, double-blind, placebo-controlled trial demonstrated that 5 days of antibiotic therapy achieved 98% clinical resolution with no relapse by 28 days, equivalent to 10-day courses. 3
- Traditional 7-14 day courses are no longer necessary for uncomplicated cases. 1
When Augmentin is the Appropriate Choice
- Augmentin is specifically recommended for cellulitis associated with human or animal bites at 875/125 mg twice daily, as it provides single-agent coverage for both streptococci and polymicrobial oral flora. 1
- For typical nonpurulent cellulitis without bite wounds, other beta-lactams (cephalexin, dicloxacillin, amoxicillin alone) are equally effective and may be preferred. 1
Critical Limitations of Augmentin
- Augmentin lacks anti-MRSA activity and should not be used for purulent cellulitis requiring MRSA coverage. 1
- In cases with penetrating trauma, injection drug use, purulent drainage, or known MRSA colonization, use MRSA-active agents instead (clindamycin monotherapy or doxycycline plus a beta-lactam). 1
- Beta-lactam monotherapy (including Augmentin) is successful in 96% of typical cellulitis cases, confirming that MRSA coverage is usually unnecessary. 1
Evidence Quality
- A systematic review and meta-analysis found no evidence supporting treatment durations longer than 5 days for uncomplicated cellulitis. 4, 5
- The evidence base consistently demonstrates that shorter courses (5 days) are as effective as longer courses (10-14 days) when clinical improvement occurs. 3, 5
Renal Dosing Adjustments
- Patients with glomerular filtration rate <30 mL/min should not receive the 875/125 mg dose. 2
- For GFR 10-30 mL/min: use 500/125 mg or 250/125 mg every 12 hours depending on severity. 2
- For GFR <10 mL/min: use 500/125 mg or 250/125 mg every 24 hours. 2
- Hemodialysis patients should receive an additional dose both during and at the end of dialysis. 2
Common Pitfalls to Avoid
- Do not extend treatment beyond 5 days simply out of habit—only extend if symptoms have not improved. 1
- Do not use Augmentin for purulent cellulitis or when MRSA risk factors are present. 1
- Do not substitute two 250/125 mg tablets for one 500/125 mg tablet, as they contain different amounts of clavulanic acid. 2