What is the treatment for soft tissue infection?

From the Guidelines

Treatment for soft tissue infections should be based on the severity of the infection and the likely etiologic agent(s), with empiric antibiotic regimens selected accordingly 1. The most recent and highest quality study, from 2021, recommends that patients with soft tissue infections receive antibiotics for uncomplicated cellulitis, with a course of 5 to 7 days being sufficient 1. In addition to antibiotics, treatment should include:

• Elevation of the affected area to reduce swelling
• Warm compresses to improve blood flow
• Pain management with acetaminophen or ibuprofen
• Proper wound care and dressing changes if applicable For abscesses, incision and drainage may be necessary before starting antibiotics. The choice of antibiotic depends on the suspected causative organism and local resistance patterns, with beta-lactam antibiotics being effective against most common skin pathogens, and vancomycin being used for suspected methicillin-resistant Staphylococcus aureus (MRSA) infections 1. For mild to moderate infections, oral antibiotics such as cephalexin or amoxicillin-clavulanate are often effective, while more severe infections may require intravenous antibiotics such as cefazolin or vancomycin 1. It is essential to monitor patients for signs of worsening infection and adjust treatment accordingly, with the goal of preventing the spread of infection and potential complications like sepsis or necrotizing fasciitis. The 2018 WSES/SIS-E consensus conference recommends that oral antibiotics such as linezolid, trimethoprim-sulfamethoxazole, or a tetracycline be used for the management of MRSA skin and soft-tissue infections, with intravenous antibiotics such as daptomycin, linezolid, or vancomycin being used for more severe infections 1. The duration of antibiotic therapy should be individualized based on the patient's clinical response, with a typical course of 7-14 days being recommended 1.

From the FDA Drug Label

The cure rates in clinically evaluable patients with complicated skin and skin structure infections were 90% in linezolid-treated patients and 85% in oxacillin-treated patients The cure rates by pathogen for microbiologically evaluable patients are presented in Table 18. The treatment for soft tissue infection, specifically complicated skin and skin structure infections, is linezolid 600 mg IV or oral every 12 hours for 10 to 14 days 2.

• Linezolid is effective against various pathogens, including Staphylococcus aureus, Methicillin-resistant S aureus, Streptococcus agalactiae, and Streptococcus pyogenes.
• Alternative treatments may include oxacillin or vancomycin, depending on the specific pathogen and patient circumstances.
• For uncomplicated skin and skin structure infections, the recommended treatment is linezolid 400 mg oral every 12 hours for 10 to 14 days 2.
• Clindamycin is also an option for treating skin and skin structure infections, with a recommended dose of 150 to 300 mg every 6 hours for serious infections 3.

From the Research

Treatment Options for Soft Tissue Infections

• The treatment for soft tissue infections varies depending on the type and severity of the infection 4, 5, 6, 7, 8.
• For erysipelas, a non-purulent infection, penicillin is the treatment of choice 4.
• For limited soft tissue infection (cellulitis), treatment consists of first- or second-generation cephalosporins or flucloxacillin (IV) 4.
• For severe cellulitis, antibiotics that target anaerobic and/or gram-negative bacteria are required, in addition to surgical management 4.
• For cutaneous abscesses, the first-line treatment is adequate drainage, with additional antibiotic therapy only required under certain circumstances 4.
• For necrotizing soft tissue infections, prompt administration of potent antimicrobial agents is essential, and surgical debridement is often necessary 5, 6.

Antibiotic Therapy

• Empirical intravenous antibacterial therapy is guided by expected pathogens, patient factors, and diagnostic procedure reports 6.
• First-generation cephalosporins or antistaphylococcal penicillins are recommended as first-line empirical therapy for community-acquired skin and soft tissue infections 6.
• Vancomycin may be an appropriate alternative when vancomycin-resistant S. aureus is highly suspected 6.
• Clindamycin is recommended for empirical antibacterial therapy in penicillin-allergic patients 6.
• Piperacillin/tazobactam with or without vancomycin is the preferred agent for empirical treatment of nosocomial complicated SSTIs 6.

Surgical Management

• Surgical debridement is often necessary for necrotizing soft tissue infections 5, 6.
• Adequate debridement of devitalized tissues and drainage of abscesses and fluid collections is an integral part of appropriate management 6.
• Surgical indication and its value are evident in many patients, and management should rely on a collaborative group with experience in this disease 7.