From the Guidelines
For patients allergic to Keflex (cefalexin) and Bactrim (trimethoprim/sulfamethoxazole), clindamycin (300-450mg orally four times daily for 7-10 days) is a recommended first-line alternative for skin coverage, as it provides good coverage against Staphylococcus and Streptococcus species, the most common skin pathogens 1. When considering alternative antibiotics for skin coverage, it's essential to prioritize the severity of the infection, local resistance patterns, patient comorbidities, and the specific nature of the previous allergic reactions.
- Doxycycline (100mg orally twice daily for 7-10 days) is another good option with broad-spectrum activity against many skin pathogens, including MRSA 1.
- Linezolid (600mg orally twice daily for 10-14 days) can be used for more severe infections, though it's typically reserved for resistant organisms due to cost and side effect profile 1.
- Macrolides like azithromycin (500mg on day 1, then 250mg daily for 4 days) may be considered but have increasing resistance rates.
- For patients with penicillin allergies who aren't allergic to all beta-lactams, amoxicillin-clavulanate (875/125mg twice daily for 7-10 days) might be suitable. It's crucial to determine if the patient has a true allergy versus an intolerance, as this may expand treatment options. The choice of antibiotic should be guided by knowledge of the local patterns of susceptibility of S. aureus, especially local rates of MRSA, and the results of cultures and antimicrobial susceptibility patterns when available 1.
From the Research
Alternative Antibiotics for Skin Coverage
In patients allergic to Keflex (cefalexin) and Bactrim (trimethoprim/sulfamethoxazole), alternative antibiotics for skin coverage can be considered based on the type of infection and the causative pathogens.
- For community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections, clindamycin is a suitable option, as it has been shown to have similar rates of treatment failure compared to trimethoprim-sulfamethoxazole 2.
- Cephalosporins with dissimilar side chains to the offending penicillin, such as third- or fourth-generation cephalosporins, may also be considered for patients with a penicillin allergy, as they carry a negligible risk of cross-allergy 3.
- Doxycycline or minocycline may be alternative options for the treatment of skin infections, including those caused by MRSA, although their use may be limited by resistance patterns and local epidemiology.
- It is essential to note that the choice of antibiotic should be guided by the results of culture and susceptibility testing, when available, to ensure the selection of an effective antibiotic.
Considerations for Antibiotic Selection
When selecting an alternative antibiotic, consider the following factors:
- The type and severity of the skin infection
- The suspected or confirmed causative pathogen(s)
- The patient's allergy history and potential for cross-reactivity
- Local resistance patterns and epidemiology
- The antibiotic's spectrum of activity, pharmacokinetics, and pharmacodynamics
By considering these factors and choosing an appropriate alternative antibiotic, healthcare providers can effectively manage skin infections in patients allergic to Keflex and Bactrim.