Is a Staphylococcus infection sensitive to Augmentin (amoxicillin-clavulanate) if the coach has tested negative for Staphylococcus?

Coagulase-Negative Staphylococcus Sensitivity to Augmentin

Augmentin (amoxicillin-clavulanate) is generally effective against methicillin-susceptible coagulase-negative staphylococci (CoNS), but it has NO activity against methicillin-resistant strains. The question appears to contain a typo ("coach negative staph"), which I interpret as coagulase-negative Staphylococcus.

Key Microbiological Considerations

Augmentin's activity against CoNS depends entirely on methicillin susceptibility status:

• Methicillin-susceptible CoNS: Augmentin is active because clavulanic acid inhibits beta-lactamase enzymes produced by these organisms 1, 2
• Methicillin-resistant CoNS: Augmentin is NOT effective, as methicillin-resistant strains remain resistant to the amoxicillin-clavulanate combination 2, 3

Clinical Context Matters

The appropriateness of Augmentin depends on the infection type and severity:

For Skin and Soft Tissue Infections (SSTI)

Augmentin is a recommended first-line agent for impetigo and mild SSTIs when methicillin-susceptible staphylococci are suspected 4:

• Adult dosing: 875/125 mg twice daily 4
• Pediatric dosing: 25 mg/kg/day of amoxicillin component in 2 divided doses 4

For Serious Infections

CoNS bacteremia (especially catheter-related) typically requires vancomycin rather than Augmentin, particularly in neutropenic or immunocompromised patients 4. CoNS are weak pathogens that rarely cause rapid deterioration, but single positive blood cultures often represent contamination 4.

Critical Pitfalls to Avoid

• Never assume susceptibility without culture data: Methicillin resistance rates vary by institution and patient population 2
• CoNS in prosthetic infections require different management: Prosthetic valve endocarditis due to CoNS requires vancomycin-based regimens, not Augmentin 4
• Community vs. hospital acquisition matters: Hospital-acquired CoNS have higher methicillin resistance rates than community strains 2

Practical Algorithm

1. Obtain cultures and susceptibility testing whenever possible before assuming Augmentin will work 4
2. For empiric therapy of mild SSTI: Augmentin is reasonable if MRSA risk is low 4
3. For serious infections or high MRSA risk: Use vancomycin instead 4
4. If methicillin-susceptible CoNS confirmed: Augmentin can be used for appropriate indications 1, 2
5. If methicillin-resistant CoNS confirmed: Switch to vancomycin or linezolid 4

The bottom line: Augmentin works against methicillin-susceptible CoNS but fails against methicillin-resistant strains—always obtain susceptibility data when treating serious CoNS infections.