What are the non-penicillin antibiotic options for treating skin infections?

From the Guidelines

Non-penicillin antibiotics for treating skin infections include several effective options, with clindamycin, trimethoprim-sulfamethoxazole, doxycycline, and linezolid being commonly used for mild to moderate infections, especially for suspected MRSA infections. For mild to moderate infections, clindamycin (300-450mg orally three times daily for 7-10 days) or trimethoprim-sulfamethoxazole (one or two double-strength tablets twice daily for 7-10 days) are commonly used, especially for suspected MRSA infections 1. Doxycycline or minocycline (100mg twice daily for 7-10 days) provide good coverage against many skin pathogens. For more severe infections, intravenous options include vancomycin (15-20mg/kg every 8-12 hours), linezolid (600mg twice daily), or daptomycin (4-6mg/kg daily) 1. Macrolides like azithromycin (500mg on day 1, then 250mg daily for 4 days) may be used for specific infections or in patients with multiple allergies. When selecting an antibiotic, consider the likely pathogen (Staphylococcus aureus and Streptococcus species are most common), local resistance patterns, infection severity, and patient factors such as kidney function and drug interactions 1. Adequate drainage of abscesses remains essential alongside antibiotic therapy for optimal treatment outcomes.

Key Considerations

• The choice of antibiotic should be based on the severity of the infection, the likely pathogen, and local resistance patterns 1.
• Clindamycin, trimethoprim-sulfamethoxazole, doxycycline, and linezolid are effective options for mild to moderate skin infections 1.
• Vancomycin, linezolid, and daptomycin are effective options for more severe infections 1.
• Macrolides like azithromycin may be used for specific infections or in patients with multiple allergies 1.

Treatment Options

• Clindamycin: 300-450mg orally three times daily for 7-10 days 1.
• Trimethoprim-sulfamethoxazole: one or two double-strength tablets twice daily for 7-10 days 1.
• Doxycycline or minocycline: 100mg twice daily for 7-10 days 1.
• Linezolid: 600mg twice daily for 7-10 days 1.
• Vancomycin: 15-20mg/kg every 8-12 hours for 7-14 days 1.
• Daptomycin: 4-6mg/kg daily for 7-14 days 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 indicated for skin and skin structure infections.

• Cephalexin is a non-penicillin antibiotic option for treating skin infections 2.
• Doxycycline is also a non-penicillin antibiotic, and it is indicated for the treatment of various infections, including those caused by gram-positive microorganisms such as Streptococcus pneumoniae, but it does not explicitly mention skin and skin structure infections as an indication in the provided text, however Doxycycline can be used for skin infections caused by specific bacteria 3.

From the Research

Non-Penicillin Antibiotic Options for Skin Infections

• First-generation cephalosporins, such as cefazolin, cephalothin, and cephalexin, can be used to treat less serious methicillin-susceptible Staphylococcus aureus (MSSA) infections, including skin and soft tissue infections 4.
• Clindamycin, lincomycin, and erythromycin are also effective against MSSA infections, including skin and soft tissue infections, and can be used in patients with penicillin hypersensitivity 4.
• For methicillin-resistant Staphylococcus aureus (MRSA) infections, lincosamides (clindamycin, lincomycin) or cotrimoxazole can be used to treat less serious infections, such as skin and soft tissue infections 4.
• New antibiotics, such as linezolid and quinupristin/dalfopristin, have good antistaphylococcal activity, but are very expensive and should be reserved for patients who fail on or are intolerant of conventional therapy or who have highly resistant strains 4.
• Cefadroxil is an alternative to cephalexin for treating MSSA infections, with similar in vitro activities 5.

Specific Antibiotic Options

• Cephalexin and cefadroxil are oral first-generation cephalosporins that can be used to treat MSSA infections, including skin and soft tissue infections 5.
• Clindamycin is effective against MRSA infections, including pneumonia, and can be used as monotherapy or in combination with other anti-MRSA antibiotics 6.
• Cotrimoxazole (trimethoprim-sulfamethoxazole) can be used to treat MRSA infections, including skin and soft tissue infections, but the evidence is limited 6.

Considerations for Antibiotic Use

• The use of a penicillin allergy screening algorithm and penicillin skin testing can help identify patients who can be transitioned to first-line β-lactam antibiotic therapy 7.
• The choice of antibiotic should be based on the severity of the infection, the susceptibility of the organism, and the patient's clinical status 4, 6.