What is the treatment for dermatitis (skin infection)?

From the Guidelines

Skin infections can be effectively treated with a combination of incision and drainage, and antimicrobial therapy, with the choice of antibiotic guided by local patterns of susceptibility, especially for MRSA, as recommended by the most recent guidelines 1.

Treatment Approach

The treatment approach for skin infections should prioritize the management of skin abscesses through incision and drainage, along with empirical antibiotic coverage pending culture results.

• For mild bacterial skin infections, topical mupirocin may be used for localized and nonbullous impetigo.
• For more extensive infections, oral antibiotics like first- or second-generation cephalosporins are recommended for methicillin-susceptible S. aureus, while trimethoprim-sulfamethoxazole, doxycycline, or clindamycin may be used for MRSA or in patients allergic to penicillin 1.

Fungal Infections

For fungal skin infections, topical antifungals such as clotrimazole or terbinafine may be effective, with the importance of keeping the infected area dry 1.

Key Considerations

• The choice of antibiotic should be guided by local patterns of susceptibility, especially for MRSA.
• Incision and drainage are crucial for the management of skin abscesses.
• Topical medications should be applied to completely dry skin for best absorption.
• If the infection worsens, seek medical attention immediately.

From the FDA Drug Label

The cure rates in clinically evaluable patients were 90% in linezolid-treated patients and 85% in oxacillin-treated patients A modified intent-to-treat (MITT) analysis of 316 linezolid-treated patients and 313 oxacillin-treated patients included subjects who met all criteria for study entry. The cure rates in the MITT analysis were 86% in linezolid-treated patients and 82% in oxacillin-treated patients. The cure rates by pathogen for microbiologically evaluable patients are presented in Table 18. The cure rates in microbiologically evaluable patients with MRSA skin and skin structure infection were 26/33 (79%) for linezolid-treated patients and 24/33 (73%) for vancomycin-treated patients In the ITT population, the cure rates were 68. 5% (165/241) in linezolid-treated patients and 64% (77/120) in comparator-treated patients, where those with indeterminate and missing outcomes were considered failures. The cure rates in the clinically evaluable patients (excluding those with indeterminate and missing outcomes) were 83% (159/192) and 73% (74/101) in the linezolid- and comparator-treated patients, respectively The cure rates by pathogen for microbiologically evaluable patients are presented in Table 19.

Skin Infection Treatment:

• Linezolid is effective in treating complicated skin and skin structure infections with cure rates of 90% in clinically evaluable patients and 86% in the modified intent-to-treat analysis.
• Linezolid is effective against MRSA skin and skin structure infections with a cure rate of 79%.
• Linezolid is effective in treating diabetic foot infections with cure rates of 68.5% in the intent-to-treat population and 83% in clinically evaluable patients.
• The cure rates for specific pathogens are as follows:
  • Staphylococcus aureus: 88%
  • Methicillin-resistant S aureus: 67% and 71%
  • Streptococcus agalactiae: 100% and 86%
  • Streptococcus pyogenes: 69% and 75% 2

From the Research

Skin Infection Treatment Options

• Various treatment options are available for skin infections, including antibiotics and antiseptics 3, 4, 5, 6, 7
• The choice of treatment depends on the severity and type of infection, as well as the presence of antibiotic resistance 3, 4, 6

Antibiotic Treatment

• Penicillinase-resistant penicillins, such as flucloxacillin and dicloxacillin, are effective against methicillin-susceptible Staphylococcus aureus (MSSA) infections 3
• Clindamycin, lincomycin, and erythromycin are also effective against MSSA infections, but may not be suitable for patients with penicillin hypersensitivity 3
• Vancomycin and teicoplanin are effective against methicillin-resistant Staphylococcus aureus (MRSA) infections, but may require parenteral administration 3, 4
• Linezolid and quinupristin/dalfopristin are newer antibiotics with good antistaphylococcal activity, but are more expensive and should be reserved for patients who fail on or are intolerant of conventional therapy 3

Topical Antibiotic Treatment

• Topical antibiotics, such as mupirocin and fusidic acid, can be effective against skin infections, but their use is limited by increasing rates of bacterial resistance and local hypersensitivity reactions 5, 7
• Retapamulin and ebselen are newer topical antibiotics with potential for use in dermatology 5
• Antiseptics, such as chlorhexidine and alcohol, can also be used to prevent and treat skin infections, but their use should be judicious to avoid coselecting for antibiotic resistance 5

Community-Acquired MRSA Infections

• Community-acquired MRSA infections can be treated with oral antimicrobial agents, such as clindamycin, doxycycline, and trimethoprim-sulfamethoxazole 4, 6
• However, the effectiveness of these agents can be impacted by the presence of inducible clindamycin resistance 6
• Daptomycin and vancomycin have demonstrated significant kill against MRSA strains in both in vitro and in vivo models 6