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Therapy of bacterial skin infections

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pajkos's version from 2017-02-20 17:52

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outpatients with nonpurulent cellulitisempirically treat for β-hemolytic streptococci (group A streptococcus) as cephalexin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, or clindamycin
outpatients with purulent cellulitis (purulent drainage or exudate in the absence of a drainable abscess)/injection drug use/other penetrating trauma/MRSA presence elsewhereempirically choose treatment to cover community-associated MRSA as well as strep, as clindamycin; work with dermatology and infectious disease specialists
MRSAClindamycin 600 mg/kg IV 300-450 mg PO Excellent tissue and abscess penetration. Risk for C. difficile Inducible resistance in MRSA.Trimethoprim-Sulfamethoxazole (TMP/SMX) 1 or 2 double-strength tablets PO BID Unreliable for S. pyogenes (will need to combine with amoxicillin/equivalent to cover for group A strep).Doxycyline, minocycline 100 mg PO BID Unreliable for S. pyogenes (will need to combine with amoxicillin/equivalent to cover for group A strep). Do not use in children < 8 years old..Linezolid 600 mg IV Q12H 600 mg PO BID Expensive. No cross-resistance with other antibiotic classes
Hospitalized MRSA patientVancomycin 30mg/kg/d in 2 divided doses IV
ErysipelasPenicillin V, amoxicillin, clindamycin, macrolide,
Non-complicated abscessusIncision and drainage
Complicated abscessusIncision and drainage + Oral antibiotics: Clindamycin, TMP-SMZ, tetracyclines
Complicated abscessus (hospitalized patient)Incision and drainage + vancomycin, linezolid, daptomycin, or telavancin
Solitary small furuncleWarm compresses to promote drainage may be sufficient
Larger furuncles and carbunclesManage as you would an abscess
FolliculitisOral or topical anti-staphylococcal agents (mupiricin, retapamulin); topical clindamycin
Impetigo if the lesions are localized in an otherwise healthy patientTopical therapy (mupirocin, retapamulin) may be equally effective to oral antibiotics
Impetigo when it’s extensive or affecting several people (close contacts)Oral antibiotics: • Dicloxacillin • Cephalexin • Erythromycin (some strains of Staphyloccocus aureus and Streptococcal pyogenes may be resistant) • Clindamycin • Amoxicillin/clavulanate
Necrotizing fasciitisConsult surgery immediately
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