From the Guidelines
For skin infections, the best antibiotic is clindamycin 300-450 mg taken orally three times daily for 5-7 days, as it provides coverage for both MRSA and streptococci, and is recommended by recent guidelines 1. When choosing an antibiotic for skin infections, it's essential to consider the type of infection, the causative pathogens, and the severity of the disease.
- For nonpurulent cellulitis, a 5- to 6-day course of antibiotics active against streptococci is recommended, particularly for patients able to self-monitor and who have close follow-up with primary care 1.
- Clindamycin is a suitable option as it is effective against MRSA and streptococci, and has been recommended by recent guidelines 1.
- Other options, such as cephalexin, dicloxacillin, and trimethoprim-sulfamethoxazole, may also be considered, but clindamycin is generally preferred due to its broad-spectrum activity 1.
- For mild superficial infections, topical mupirocin (Bactroban) 2% ointment applied three times daily for 5-10 days may be sufficient 1. It's crucial to complete the full course of antibiotics even if symptoms improve quickly, and to seek medical attention immediately if the infection shows signs of worsening, such as increasing redness, warmth, swelling, or fever.
- The choice of antibiotic should be guided by the severity of the infection, the presence of comorbidities, and the risk of antibiotic resistance 1.
- Recent guidelines recommend a shorter course of antibiotics, such as 5-7 days, for uncomplicated skin infections, but the treatment duration may need to be extended in certain cases 1.
From the FDA Drug Label
For the following infections, a dosage of 500 mg may be administered every 12 hours: streptococcal pharyngitis, skin and skin structure infections, and uncomplicated cystitis in patients over 15 years of age.
- Cephalexin is an option for skin and skin structure infections, with a recommended dosage of 500 mg every 12 hours for adults over 15 years of age 2.
- The dosage may be adjusted based on the severity of the infection, with larger doses potentially needed for more severe cases.
- Cephalexin can be considered a suitable anabolic for skin infections, given its recommended use for this type of infection.
From the Research
Antibiotic Options for Skin Infections
- Minocycline is effective for treating uncomplicated skin and soft-tissue infections caused by community-acquired meticillin-resistant Staphylococcus aureus (MRSA) 3
- Ofloxacin and cephalexin are safe and effective for treating skin and soft-tissue infections, with ofloxacin showing a higher susceptibility rate against aerobic pathogens 4
- Clindamycin and trimethoprim-sulfamethoxazole have similar efficacy and side-effect profiles for treating uncomplicated skin infections, including cellulitis and abscesses 5
- For impetigo, treatment options include topical antibiotics such as mupirocin, retapamulin, and fusidic acid, as well as oral antibiotics like amoxicillin/clavulanate, dicloxacillin, and clindamycin 6
- Trimethoprim-sulfamethoxazole, cephalexin, and clindamycin are commonly used empiric outpatient therapies for cellulitis, with trimethoprim-sulfamethoxazole showing a higher treatment success rate than cephalexin 7
Considerations for Antibiotic Resistance
- The increasing prevalence of antibiotic-resistant bacteria, including methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus, should be considered when selecting empiric treatment 6, 7
- Antibiotics with activity against community-associated MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, are preferred empiric therapy for outpatients with cellulitis in areas with high MRSA prevalence 7