What is the recommended antibiotic treatment for a leg wound with purulent discharge?

From the Guidelines

For a leg wound with purulent discharge, the most appropriate empiric antibiotic treatment is clindamycin 300-450 mg orally four times daily for 5-10 days, as it provides coverage for both Staphylococcus aureus and Streptococcus species, including MRSA 1. This recommendation is based on the most recent and highest quality study available, which suggests that clindamycin is an effective option for treating skin and soft tissue infections, including those caused by MRSA 1. Some key points to consider when treating a leg wound with purulent discharge include:

• Proper wound care, including cleaning with sterile saline, debridement of necrotic tissue if present, and appropriate dressing changes
• Culturing the purulent discharge before starting antibiotics, if possible, to guide targeted therapy once results are available
• Monitoring for signs of worsening infection, such as fever, increasing pain, spreading redness, or red streaking from the wound, and seeking immediate medical attention if these symptoms develop
• Considering the patient's risk factors and local prevalence of MRSA when selecting an antibiotic regimen
• Individualizing the duration of antibiotic therapy based on the patient's clinical response, with 5-10 days of therapy typically recommended for outpatients with purulent cellulitis 1. It's also important to note that the use of rifampin as a single agent or as adjunctive therapy for the treatment of skin and soft tissue infections is not recommended 1. In addition, hospitalized patients with complicated skin and soft tissue infections may require broader-spectrum antibiotics and closer monitoring, and should be treated with intravenous vancomycin, oral or intravenous linezolid, or other MRSA-active therapies as needed 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION The penicillinase-resistant penicillins are available for oral administration and for intramuscular and intravenous injection. Bacteriologic studies to determine the causative organisms and their sensitivity to the penicillinase-resistant penicillins should always be performed. In severe staphylococcal infections, therapy with penicillinase-resistant penicillins should be continued for at least 14 days.

The best oral antibiotic for a wound on the leg with pus is dicloxacillin.

• The recommended dosage is 125-250 mg every 6 hours for mild to moderate infections, and 250 mg every 6 hours for severe infections.
• It is essential to determine the causative organisms and their sensitivity to the antibiotic through bacteriologic studies.
• The treatment should be continued for at least 14 days in severe staphylococcal infections, and for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative 2.
• Alternatively, clindamycin can be used, with a recommended dosage of 150-300 mg every 6 hours for serious infections, and 300-450 mg every 6 hours for more severe infections 3.

From the Research

Antibiotic Treatment for Leg Wounds with Purulent Discharge

• The recommended antibiotic treatment for a leg wound with purulent discharge depends on the severity of the infection and the suspected causative organism 4, 5.
• For methicillin-susceptible Staphylococcus aureus (MSSA) infections, penicillinase-resistant penicillins (flucloxacillin, dicloxacillin) are the antibiotics of choice, while first-generation cephalosporins (cefazolin, cephalothin, and cephalexin) and clindamycin are alternative options 4.
• For methicillin-resistant Staphylococcus aureus (MRSA) infections, vancomycin or teicoplanin are the preferred treatments, with lincosamides (clindamycin, lincomycin) or cotrimoxazole being used for less severe cases 4, 6.
• Cephalexin is also an effective antibiotic for the treatment of streptococcal and staphylococcal skin infections, including those caused by MRSA 7.
• The choice of antibiotic should be guided by the severity of the infection, local susceptibility patterns, and drug-related safety, tolerability, and cost 5.
• Bacterial wound cultures are important for characterizing local susceptibility patterns and guiding definitive antibiotic therapy 5.

Specific Antibiotic Options

• Cephalexin: effective against streptococcal and staphylococcal skin infections, including MRSA 7.
• Clindamycin: alternative option for MSSA infections and preferred treatment for less severe MRSA infections 4, 5.
• Vancomycin: preferred treatment for severe MRSA infections 4, 6.
• Teicoplanin: alternative treatment for severe MRSA infections, especially in patients allergic to vancomycin 4.

Treatment Duration and Response

• Response to therapy is expected within the first few days, with 5 to 7 days of therapy typically adequate to achieve cure 5.
• Definitive antibiotic therapy should be guided by the results of bacterial wound cultures and the severity of the infection 5.