Augmentin Dosage for Hand Laceration
For a simple hand laceration in a patient without penicillin allergy, prescribe Augmentin (amoxicillin-clavulanate) 875 mg/125 mg orally twice daily for 5-7 days. 1
Standard Adult Dosing
The FDA-approved dosing for skin and soft tissue infections is straightforward 1:
- Standard dose: 500 mg/125 mg every 12 hours
- More severe infections or respiratory involvement: 875 mg/125 mg every 12 hours OR 500 mg/125 mg every 8 hours 1
For hand lacerations, which represent a moderate infection risk due to contamination potential and functional importance of the hand, the 875 mg/125 mg twice daily regimen is most appropriate 1.
When Augmentin is Specifically Indicated
Augmentin should be chosen over plain amoxicillin when 2:
- The patient has taken amoxicillin within the previous 30 days 2
- The wound is contaminated or has high infection risk (animal/human bites, water exposure, significant contamination) 2
- Coverage for beta-lactamase producing organisms (Pasteurella multocida, Staphylococcus aureus, anaerobes) is needed 2
The IDSA guidelines specifically recommend amoxicillin-clavulanate for bite wounds and contaminated injuries because agents like cephalexin and dicloxacillin have poor activity against Pasteurella multocida and certain anaerobes 2.
Administration Considerations
Take at the start of meals to enhance clavulanate absorption and minimize gastrointestinal side effects 1. This is a critical counseling point, as GI intolerance is the most common adverse effect.
Duration of Therapy
5-7 days is the standard duration for uncomplicated skin and soft tissue infections 3, 4. Clinical improvement should be evident within 48-72 hours 3. If no improvement occurs by this timeframe, reassess for complications (abscess formation, deeper infection, resistant organisms) 4.
Common Pitfalls to Avoid
- Do NOT substitute two 250 mg/125 mg tablets for one 500 mg/125 mg tablet - they contain different amounts of clavulanate and are not equivalent 1
- Do NOT underdose - the 250 mg/125 mg formulation every 8 hours is for less severe infections only 1
- Do NOT prescribe if the patient has a documented penicillin allergy - use clindamycin 300-450 mg four times daily instead 4
Special Circumstances Requiring Higher Doses
Consider the higher 2000 mg/125 mg twice daily formulation (Augmentin XR) if 3:
- Recent antibiotic use (within 30 days)
- Healthcare exposure or high community resistance rates
- Immunocompromised status or significant comorbidities (diabetes, chronic organ disease)
- Age >65 years
However, for straightforward hand lacerations in otherwise healthy patients, the standard 875 mg/125 mg formulation is sufficient 1.
Evidence Quality Note
While the IDSA guidelines strongly support amoxicillin-clavulanate for contaminated wounds and bite injuries (Grade A-I and B-II evidence) 2, there is actually limited high-quality evidence specifically for prophylactic antibiotics in simple hand lacerations 5. The practice is based on expert consensus regarding infection risk in functionally critical areas with high contamination potential 2. Despite this evidence gap, the degree of contamination remains the most important factor in deciding whether to prescribe antibiotics 5.