What is the recommended treatment course for a patient with a skin infection taking Augmentin (amoxicillin/clavulanate) and Medley, and how should they monitor their condition?

Treatment Course for Skin Infections with Augmentin

For uncomplicated skin infections, Augmentin (amoxicillin-clavulanate) should be taken at 875/125 mg twice daily or 500 mg three times daily for 5-10 days, with each dose taken with food to minimize gastrointestinal upset. 1, 2

Appropriate Use of Augmentin for Skin Infections

Augmentin is an appropriate choice for skin infections when MRSA is not suspected or when mixed infections with streptococci and methicillin-sensitive S. aureus are likely. 3, 1 The combination of amoxicillin with clavulanic acid provides coverage against beta-lactamase-producing organisms commonly found in skin infections. 4, 5

When Augmentin is Recommended:

• Uncomplicated cellulitis without purulence or systemic signs 1
• Animal or human bite wounds (875/125 mg twice daily provides coverage for Pasteurella, anaerobes, and oral flora) 3, 1
• Infected eczema, infected trauma, or surgical site infections when MRSA risk factors are absent 4, 6

When Augmentin is NOT Recommended:

• If MRSA risk factors are present (injection drug use, known MRSA colonization, penetrating trauma, or systemic signs of infection), vancomycin or another MRSA-active agent should be used instead 3, 1
• For severe infections with systemic toxicity, broad-spectrum IV therapy with vancomycin plus piperacillin-tazobactam is preferred 3, 1

Dosing and Administration

Take each dose with a meal or snack to reduce gastrointestinal side effects. 2 The standard adult dosing options are:

• 875/125 mg twice daily (every 12 hours) 3, 2
• 500 mg three times daily (every 8 hours) 3

Complete the full course even if symptoms improve early, as stopping prematurely increases resistance risk and treatment failure. 2

Treatment Duration

For uncomplicated cellulitis, treat for at least 5 days and continue until clinical improvement is evident. 1 Most skin infections require 7-10 days of therapy. 3, 1

Extend treatment beyond 5 days if no improvement is seen, and reassess for alternative diagnoses or resistant organisms. 1

Monitoring During Treatment

Clinical Response Indicators:

• Reduction in erythema, warmth, and swelling within 48-72 hours 1
• Resolution of fever and systemic symptoms 1
• Decreasing pain and tenderness at the infection site 1

Warning Signs Requiring Reassessment:

• Worsening erythema or extension beyond initial margins suggests treatment failure or resistant organism 3, 1
• Development of purulent drainage may indicate abscess formation requiring incision and drainage 3
• Persistent or worsening fever after 48-72 hours warrants cultures and consideration of MRSA coverage 3, 1
• Severe diarrhea, especially with blood or occurring weeks after treatment, may indicate Clostridium difficile infection 2

Common Side Effects and Management

Diarrhea (9%) and nausea (9%) are the most common side effects. 4 These typically resolve when the antibiotic is discontinued. 2

Contact your physician if diarrhea is severe or lasts more than 2-3 days, as this may indicate C. difficile infection, which can occur up to 2 months after completing antibiotics. 2

Allergic reactions can occur since Augmentin contains a penicillin-class drug—seek immediate care for rash, hives, or difficulty breathing. 2

When to Escalate Care

Seek urgent evaluation if any of the following develop:

• Rapidly spreading erythema with severe pain disproportionate to exam findings (suggests necrotizing fasciitis) 3, 1
• Systemic toxicity with hypotension, altered mental status, or organ dysfunction 3, 1
• Crepitus, bullae, or skin necrosis (requires immediate surgical consultation) 3, 1
• No improvement after 48-72 hours of appropriate therapy 3, 1

Note on "Medley"

The term "Medley" is unclear in this context—if this refers to a specific medication, clarify with your prescriber to ensure there are no drug interactions or duplicative therapy with Augmentin.