What is the recommended discharge (D/C) instruction and antibiotic regimen, such as doxycycline, for patients with soft tissue infections?

From the Guidelines

For patients with soft tissue infections, the recommended discharge instructions include a 7-14 day course of antibiotics, with doxycycline 100 mg twice daily being a common first-line option, especially for suspected methicillin-resistant Staphylococcus aureus (MRSA) infections, as recommended by the 2018 WSES/SIS-E consensus conference 1. Patients should complete the entire antibiotic course even if symptoms improve before completion. Alternative antibiotics include trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets twice daily, clindamycin 300-450 mg four times daily, or cephalexin 500 mg four times daily for non-MRSA infections. Some key points to consider when choosing an antibiotic regimen include the severity of the infection, the presence of comorbidities, and the potential for resistance to certain antibiotics, as outlined in the clinical practice guidelines by the Infectious Diseases Society of America 1. Patients should elevate the affected area when possible, apply warm compresses for 15-20 minutes 3-4 times daily to improve blood flow and antibiotic penetration, and take over-the-counter pain relievers like acetaminophen or ibuprofen as needed. They should monitor for worsening symptoms such as increasing redness, swelling, pain, fever above 101°F, or red streaking from the infection site, which warrant immediate medical attention. Doxycycline is particularly effective against a broad spectrum of bacteria including MRSA and works by inhibiting bacterial protein synthesis, though patients should be advised to avoid sun exposure while taking it and not to take it with dairy products or antacids. It's also important to note that the use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended, as stated in the clinical practice guidelines by the Infectious Diseases Society of America 1. In addition, for hospitalized patients with complicated SSTI, empirical therapy for MRSA should be considered pending culture data, with options including IV vancomycin, linezolid, daptomycin, telavancin, or clindamycin, as recommended by the 2018 WSES/SIS-E consensus conference 1. Overall, the choice of antibiotic regimen and discharge instructions should be individualized based on the patient's clinical response and the severity of the infection.

From the FDA Drug Label

Adults: The usual dose of oral doxycycline is 200 mg on the first day of treatment (administered 100 mg every 12 hours) followed by a maintenance dose of 100 mg/day For children above eight years of age: The recommended dosage schedule for children weighing 100 pounds or less is 2 mg/lb of body weight divided into two doses on the first day of treatment, followed by 1 mg/lb of body weight given as a single daily dose or divided into two doses, on subsequent days. The recommended discharge instruction and antibiotic regimen for patients with soft tissue infections is 100 mg of doxycycline orally every 12 hours for adults, and 2 mg/lb of body weight divided into two doses on the first day of treatment, followed by 1 mg/lb of body weight given as a single daily dose or divided into two doses, on subsequent days for children above eight years of age weighing 100 pounds or less 2.

• The dosage may vary depending on the severity of the infection.
• It is essential to administer adequate amounts of fluid along with the drug to reduce the risk of esophageal irritation and ulceration.
• Food or milk may be given with doxycycline if gastric irritation occurs.

From the Research

Discharge Instructions for Soft Tissue Infections

The recommended discharge (D/C) instruction and antibiotic regimen, such as doxycycline, for patients with soft tissue infections can be summarized as follows:

• The use of oral tetracyclines, including doxycycline, is recommended for the treatment of adult outpatients with skin and soft tissue infections (SSTIs) 3.
• Shorter courses of antibiotics are recommended, with a median duration of antibiotic administration of 9.8 days overall, and 7.0 days after the final debridement 4.
• The decision to switch to an oral treatment and/or to discharge a patient with skin and soft tissue infections should be based on early assessment of patient's clinical conditions and response to treatment 5.
• The role of stewardship programmes will continue to expand, and management should rely on a collaborative group with experience in this disease 6.
• Simple antibiotics, such as cephalexin, may be sufficient for the treatment of uncomplicated soft tissue infections, with clinical response rates exceeding 95% 7.

Antibiotic Regimen

The choice of antibiotic regimen for soft tissue infections depends on various factors, including:

• The severity of the infection
• The presence of complicating infections
• The susceptibility of the pathogens to different antibiotics
• The patient's clinical conditions and response to treatment
• Doxycycline is a recommended option for the treatment of SSTIs, especially when methicillin-resistant Staphylococcus aureus is of clinical concern 3.

Discharge Criteria

The criteria for discharging a patient with soft tissue infections include:

• Clinical improvement, such as reduction in symptoms and signs of infection
• Completion of the recommended course of antibiotic treatment
• Ability to manage the infection at home, with or without oral antibiotics
• Early assessment of patient's clinical conditions and response to treatment can facilitate patients' discharge 5.