What is the next antibiotic choice for a non-healing foot laceration previously treated with trimethoprim/sulfamethoxazole (TMP/SMX)?

From the Guidelines

For a laceration on the foot not responding to trimethoprim/sulfamethoxazole, the next choice of antibiotics should be doxycycline or cephalexin, considering the potential for polymicrobial infections including MRSA 1.

Key Considerations

• The choice of antibiotic should be based on the severity of the infection, the likelihood of MRSA, and the patient's medical history and allergies.
• Doxycycline can be given at a dose of 100 mg orally twice a day for 7-10 days, or cephalexin at a dose of 500 mg orally four times a day for 7-10 days.
• It's crucial to assess for any signs of infection severity, such as increased redness, swelling, or purulent discharge, and consider wound cultures if the infection does not improve with the new antibiotic regimen.
• The Infectious Diseases Society of America recommends considering vancomycin, linezolid, or daptomycin for MRSA infections, but these may not be necessary for initial treatment of a foot laceration 1.
• The patient's response to treatment should be closely monitored, and the antibiotic regimen adjusted as needed based on culture and sensitivity results 1.

From the Research

Next Antibiotic Choice for Non-Healing Foot Laceration

If a non-healing foot laceration was previously treated with trimethoprim/sulfamethoxazole (TMP/SMX), the next antibiotic choice could be:

• Minocycline, as it is reliably effective in treating uncomplicated community-acquired MRSA (CA-MRSA) skin and soft-tissue infections when doxycycline or TMP-SMX fails 2
• Clindamycin, as it has been shown to be effective in treating uncomplicated skin infections, including cellulitis and abscesses, with similar cure rates to TMP-SMX 3
• Cephalexin, although it may not be the best choice as it has been shown to have lower treatment success rates compared to TMP-SMX and clindamycin in some studies 4, 5

Considerations for Antibiotic Choice

When choosing an antibiotic, consider the following factors:

• The presence of community-acquired MRSA (CA-MRSA) in the infection, as antibiotics with activity against CA-MRSA (such as clindamycin and TMP-SMX) may be preferred 5
• The severity of the infection, as more severe infections may require more aggressive treatment 5
• The patient's medical history and potential allergies or interactions with certain antibiotics

Additional Options

Other antibiotics that may be considered for the treatment of skin and soft tissue infections include:

• Doxycycline, although it may not be as effective as minocycline in treating CA-MRSA infections 2
• Sulfamethoxazole-trimethoprim (SXT), which has been shown to be effective in treating impetigo, purulent cellulitis, and abscesses, but may not be the best choice for non-purulent cellulitis 6