From the Guidelines
For skin infections, the most effective alternative antibiotic options include trimethoprim-sulfamethoxazole (TMP-SMX), doxycycline, clindamycin, and linezolid, with the choice of treatment guided by infection severity, suspected pathogens, patient allergies, and local resistance patterns, as recommended by the Infectious Diseases Society of America 1.
Alternative Antibiotic Options
- Oral options:
- Trimethoprim-sulfamethoxazole (TMP-SMX) at 1-2 DS tablets twice daily for 7-14 days, effective against MRSA
- Doxycycline 100mg twice daily for 7-14 days
- Clindamycin 300-450mg four times daily for 7-14 days
- Linezolid 600mg twice daily for 7-14 days for more severe cases
- Topical treatment:
- Mupirocin 2% ointment applied three times daily for 5-10 days
- Retapamulin 1% ointment applied twice daily for 5 days
Special Considerations
- Incision and drainage remains essential for abscesses, sometimes making antibiotics unnecessary for simple, drained abscesses under 2cm
- In cases of penicillin allergy, macrolides like azithromycin 500mg on day 1 followed by 250mg daily for 4 days can be used, though resistance is increasing
- For severe infections requiring IV therapy, vancomycin, daptomycin, or ceftaroline may be necessary, as recommended by the Infectious Diseases Society of America 1
Treatment Guidance
- Treatment choice should be guided by infection severity, suspected pathogens (particularly MRSA prevalence), patient allergies, and local resistance patterns
- Cultures from abscesses and other purulent SSTIs are recommended in patients treated with antibiotic therapy, patients with severe local infection or signs of systemic illness, patients who have not responded adequately to initial treatment, and if there is concern for a cluster or outbreak 1
From the FDA Drug Label
- 5 Complicated Skin and Skin Structure Infections Three hundred ninety-nine patients were enrolled in an open-label, randomized, comparative study for complicated skin and skin structure infections. The patients were randomized to receive either levofloxacin 750 mg once daily (IV followed by oral), or an approved comparator for a median of 10 ± 4. 7 days. Among those who could be evaluated clinically 2 to 5 days after completion of study drug, overall success rates (improved or cured) were 116/138 (84.1%) for patients treated with levofloxacin and 106/132 (80. 3%) for patients treated with the comparator.
Alternative options for antibiotic treatment of skin infections are not explicitly listed in the provided drug label. However, it is mentioned that levofloxacin was compared to an approved comparator in the treatment of complicated skin and skin structure infections, suggesting that there are other approved antibiotics that can be used as alternatives.
- The comparator used in the study is not specified, but the results show that it had a similar success rate to levofloxacin in treating complicated skin and skin structure infections 2.
From the Research
Alternative Options for Antibiotic Treatment of Skin Infections
- The choice of antibiotic for skin infections depends on the severity of the infection, local susceptibility patterns, and drug-related safety, tolerability, and cost 3.
- For empiric outpatient therapy, trimethoprim-sulfamethoxazole, cephalexin, or clindamycin can be used to treat cellulitis, with trimethoprim-sulfamethoxazole having a higher treatment success rate than cephalexin 4.
- Clindamycin is effective against community-associated methicillin-resistant Staphylococcus aureus (MRSA) and can be used as an alternative to other antibiotics 4.
- However, the addition of clindamycin to flucloxacillin does not improve outcomes in the treatment of limb cellulitis and may increase the risk of diarrhea 5.
- Topical antibiotics can be used for superficial infections of limited extent and for the prevention of recurrences in carriers of S. aureus, and should be combined with the use of topical disinfectants 6.
Considerations for Antibiotic Choice
- The development of modern antibiotics has improved the therapy of cutaneous bacterial infections, particularly those caused by Staphylococcus aureus 6.
- Bacterial wound cultures are important for characterizing local susceptibility patterns and guiding antibiotic choice 3.
- The treatment of selected bacterial skin infections, such as secondarily infected dermatoses, cellulitis, and streptococcal carriage, should be based on clinical examples and evidence-based guidelines 6.