What is the recommended dosing for Cephalexin (Keflex) in the treatment of skin wounds?

From the Guidelines

Keflex (cephalexin) should be dosed at 20 mg per kg per dose twice daily (maximum = 500 mg per dose) for 10 days when treating skin wounds in patients with penicillin allergy. This dosing recommendation is based on the strongest and most recent evidence available, specifically the 2013 IDSA guideline update for managing group A streptococcal pharyngitis 1.

Key Considerations

• The recommended dose is 20 mg per kg per dose twice daily, with a maximum dose of 500 mg per dose.
• The duration of treatment is 10 days.
• This recommendation is classified as strong, with high-quality evidence.

Important Notes

• Keflex is effective against common skin bacteria, including Staphylococcus aureus and Streptococcus species.
• Patients should take the full course of antibiotics, even if symptoms improve before completion.
• Common side effects include diarrhea, nausea, and rash.
• Patients with penicillin allergy may have cross-reactivity with Keflex, so caution is needed.

Wound Care

• The wound should be kept clean, with appropriate dressing changes.
• Patients should monitor for increasing redness, warmth, swelling, or drainage that might indicate worsening infection requiring medical reassessment.

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 usual recommended daily dosage for pediatric patients is 25 to 50 mg/kg in divided doses For streptococcal pharyngitis in patients over 1 year of age and for skin and skin structure infections, the total daily dose may be divided and administered every 12 hours.

The recommended dosing for skin wounds is:

• For adults: 500 mg every 12 hours
• For pediatric patients: 25 to 50 mg/kg in divided doses, which can be administered every 12 hours for skin and skin structure infections 2

From the Research

Keflex Dosing for Skin Wounds

• Keflex, also known as cephalexin, is an antibiotic used to treat bacterial skin infections 3.
• The dosage of Keflex for skin wounds is not explicitly stated in the provided studies, but it is compared to dicloxacillin in the treatment of staphylococcal skin infections 3.
• Cephalexin, given twice daily, was found to be equally effective as dicloxacillin, given four times daily, in treating staphylococcal skin and skin structure infections 3.
• Twice-daily dosing with oral antibiotics like cephalexin is convenient and may enhance compliance 3.

Treatment of Skin Infections

• The treatment of skin infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA), often involves the use of antibiotics such as doxycycline, minocycline, and trimethoprim-sulfamethoxazole 4, 5, 6, 7.
• Cephalexin is not explicitly mentioned as a treatment option for MRSA infections in the provided studies, but it is effective against staphylococcal skin infections 3.
• The choice of antibiotic depends on the severity of the infection, the suspected causative organism, and the patient's medical history 5, 6, 7.

Antibiotic Resistance

• Antibiotic resistance is a concern in the treatment of skin infections, with MRSA being a common cause of purulent skin and soft tissue infections 4, 7.
• The use of antibiotics like doxycycline and trimethoprim-sulfamethoxazole is recommended for the treatment of MRSA infections, as they are often effective against these organisms 4, 7.
• Cephalexin is effective against staphylococcal skin infections, but its efficacy against MRSA is not explicitly stated in the provided studies 3.