What is the recommended treatment with Augmentin (amoxicillin and clavulanic acid) for a patient with a human bite and potential impaired renal function, considering a history of allergies to penicillin or other beta-lactam antibiotics?

Treatment of Human Bites with Augmentin

First-Line Recommendation

Amoxicillin-clavulanate (Augmentin) 875/125 mg orally twice daily is the definitive first-line treatment for human bite wounds, providing comprehensive coverage against the polymicrobial oral flora including Eikenella corrodens, staphylococci, streptococci, and anaerobes. 1, 2

Standard Dosing for Normal Renal Function

• Adults: Amoxicillin-clavulanate 875/125 mg orally twice daily for 7-10 days for established infection 1, 2
• Prophylaxis for high-risk wounds: 3-5 days of preemptive therapy 2
• Administration: Take at the start of meals to enhance clavulanate absorption and minimize gastrointestinal side effects 3

Dosing Adjustments for Impaired Renal Function

For patients with severe renal impairment, dose reduction is mandatory to prevent drug accumulation: 3

• GFR 10-30 mL/min: Amoxicillin-clavulanate 500/125 mg every 12 hours (do NOT use the 875/125 mg formulation) 3
• GFR <10 mL/min: Amoxicillin-clavulanate 500/125 mg or 250/125 mg every 24 hours 3
• Hemodialysis patients: 500/125 mg or 250/125 mg every 24 hours, with an additional dose during and at the end of dialysis 3
• Critical caveat: Patients with GFR <30 mL/min should NOT receive the 875/125 mg tablet 3

Alternative Regimens for Penicillin Allergy

For patients with documented penicillin or beta-lactam allergy, alternative regimens must provide adequate coverage against Eikenella corrodens: 1, 2

Preferred Alternative (Non-Anaphylactic Allergy)

• Doxycycline 100 mg orally twice daily - provides good activity against Eikenella species, staphylococci, and anaerobes, though some streptococci may be resistant 1, 2

Additional Alternatives

• Moxifloxacin 400 mg orally once daily - offers monotherapy with anaerobic coverage 1, 2
• Combination therapy: Ciprofloxacin 500-750 mg twice daily OR levofloxacin 750 mg daily PLUS metronidazole 500 mg three times daily 1, 2

Severe Infections Requiring IV Therapy

For severe infections, hospitalized patients, or those unable to tolerate oral therapy: 1, 2

• Ampicillin-sulbactam 1.5-3.0 g IV every 6 hours 1, 2
• Carbapenems (ertapenem, imipenem, or meropenem) for critically ill patients 1, 2

Critical Antibiotics to AVOID

The following regimens have inadequate coverage and should never be used as monotherapy for human bites: 1, 2

• Clindamycin alone - misses Eikenella corrodens (which is resistant to clindamycin) 1, 2
• First-generation cephalosporins (cephalexin, cefazolin) - miss E. corrodens and anaerobes 2
• Trimethoprim-sulfamethoxazole or metronidazole alone - inadequate spectrum 1, 2

Additional Management Considerations

Beyond antibiotic selection, comprehensive wound management is essential: 1, 2

• Tetanus prophylaxis: Administer if not vaccinated within 10 years 2
• Wound cultures: Obtain if infection is severe, not responding to therapy, or patient is immunocompromised 2
• MRSA consideration: Amoxicillin-clavulanate does not cover MRSA; add vancomycin or linezolid if MRSA is suspected 1
• Wound closure: Primary closure of human bite wounds (especially those with exposed cartilage) is associated with higher infection rates; delayed closure after >24 hours is preferred for high-risk wounds 4

Special Populations

Hepatically impaired patients: Dose with caution and monitor hepatic function at regular intervals 3

Pediatric patients ≥40 kg: Dose according to adult recommendations 3