From the Guidelines
For a skin infection, I recommend using an antibiotic medication such as clindamycin (300mg four times daily for 7-10 days) or linezolid (600mg twice daily for 7-10 days) for more widespread or severe infections, as suggested by the most recent and highest quality study 1.
Key Considerations
- The choice of antibiotic should be guided by the severity of the infection, the presence of systemic signs of infection, and the patient's underlying health status.
- Incision and drainage is the primary treatment for cutaneous abscesses, and antibiotic therapy may be recommended in certain cases, such as severe or extensive disease, or rapid progression in the presence of associated cellulitis.
- For empirical coverage of CA-MRSA in outpatients with SSTI, oral antibiotic options include clindamycin, trimethoprim-sulfamethoxazole, a tetracycline, and linezolid.
- The duration of therapy should be individualized based on the patient's clinical response, but typically ranges from 5 to 14 days.
Important Points to Note
- Skin infections are typically caused by bacteria, such as Staphylococcus or Streptococcus, that enter through breaks in the skin.
- If the infection does not improve within 2-3 days of treatment, or if there are signs of worsening infection, such as increasing redness, warmth, swelling, pus, or fever, medical attention should be sought immediately.
- The use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended 2, 3.
- Cultures from abscesses and other purulent SSTIs are recommended in patients treated with antibiotic therapy, patients with severe local infection or signs of systemic illness, patients who have not responded adequately to initial treatment, and if there is concern for a cluster or outbreak 2, 4.
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. The recommended dosage for skin and skin structure infections is 500 mg every 12 hours, for patients over 15 years of age, using cephalexin 5.
- The dosage may be adjusted based on the severity of the infection.
- It is essential to complete the full course of therapy to ensure effective treatment and prevent the development of antibiotic-resistant bacteria.
From the Research
Skin Infection Medications
- Various medications are used to treat skin infections, including those caused by Staphylococcus aureus 6.
- For methicillin-susceptible S. aureus (MSSA) infections, penicillinase-resistant penicillins (flucloxacillin, dicloxacillin) are the antibiotics of choice, while first generation cephalosporins (cefazolin, cephalothin and cephalexin), clindamycin, lincomycin, and erythromycin have important therapeutic roles in less serious MSSA infections such as skin and soft tissue infections 6.
- For methicillin-resistant S. aureus (MRSA) infections, parenteral vancomycin or teicoplanin are used to treat serious infections, while lincosamides (clindamycin, lincomycin) or cotrimoxazole are used to treat less serious community-acquired MRSA infections such as skin and soft tissue infections 6.
Topical Antibiotics
- Mupirocin is a topical antibiotic effective against a wide range of Gram-positive bacteria, including staphylococci and most streptococci, and is moderately active against Gram-negative bacteria 7.
- Mupirocin 2% ointment has been shown to be effective in the treatment of primary and secondary skin infections, with over 90% of patients achieving clinical cure or improvement 7.
- Intranasal 2% calcium mupirocin has been shown to be effective in the eradication of nasal carriage of S. aureus, including MRSA, with over 95% of subjects achieving elimination of the bacteria 7.
Oral Antibiotics
- Minocycline is often preferred over trimethoprim-sulfamethoxazole or doxycycline for the treatment of community-acquired MRSA skin and soft-tissue infections, as it is reliably effective in eradicating the infection 8.
- Clindamycin, doxycycline, and trimethoprim-sulfamethoxazole are commonly used oral antibiotics for the treatment of community-acquired MRSA, but may not always be effective in eradicating the infection 8.
Comparison of Topical Antibiotics
- Mupirocin has been compared to sodium fusidate in the treatment of superficial skin infections, with both treatments showing similar efficacy, but mupirocin being more effective in the treatment of acute primary skin infections and impetigo 9.
- Mupirocin was also more effective in eliminating Staphylococcus aureus and/or beta-haemolytic streptococci, with 96% of patients treated with mupirocin achieving elimination of the bacteria, compared to 88% of patients treated with sodium fusidate 9.