From the Guidelines
For a patient with a penicillin allergy who has a soft tissue infection, clindamycin is an excellent alternative to Augmentin, with a typical adult dosage of 300-450 mg orally every 6-8 hours for 7-10 days, depending on infection severity, as recommended by the most recent guidelines 1.
Key Considerations
- The choice of alternative antibiotic should consider the specific infection type, local resistance patterns, and patient factors such as kidney function and medication interactions.
- Clindamycin specifically inhibits bacterial protein synthesis rather than attacking cell walls like penicillins do, making it safe for allergic patients.
- Other good options include doxycycline (100 mg twice daily), trimethoprim-sulfamethoxazole (one double-strength tablet twice daily), or a fluoroquinolone like levofloxacin (750 mg once daily), as suggested by previous guidelines 1.
Important Factors
- Patients should complete the full course of antibiotics even if symptoms improve quickly to prevent recurrence and antibiotic resistance.
- The most recent guidelines recommend linezolid, trimethoprim-sulfamethoxazole, a tetracycline (doxycycline or minocycline), or tedizolid for oral antibiotic coverage of MRSA in patients with SSTI 1.
- Intravenous antibiotic coverage of MRSA in patients with SSTI may include daptomycin, IV linezolid, IV ceftaroline, IV dalbavancin, IV vancomycin, IV tigecycline, or IV tedizolid, as recommended by the 2018 WSES/SIS-E consensus conference 1.
From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. Serious skin and soft tissue infections; To reduce the development of drug-resistant bacteria and maintain the effectiveness of clindamycin hydrochloride and other antibacterial drugs, clindamycin hydrochloride should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria
For a patient with a penicillin allergy and a soft tissue infection, an alternative to Augmentin (amoxicillin/clavulanic acid) is clindamycin 2.
- Clindamycin is indicated for the treatment of serious skin and soft tissue infections.
- It should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.
- Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin.
From the Research
Alternatives to Augmentin for Soft Tissue Infections in Patients with Penicillin Allergy
- For patients with a penicillin allergy, alternative antibiotics such as clindamycin, lincomycin, or erythromycin can be used to treat soft tissue infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) 3.
- However, it's essential to note that clindamycin has been associated with an increased risk of surgical site infections in certain cases, such as head and neck free tissue transfer 4.
- In cases where the patient has a true penicillin allergy, broader gram-negative coverage with alternative antibiotics such as cefuroxime may be recommended 4.
- Cefazolin can be a safe option for patients with a penicillin allergy, except in cases of severe, life-threatening delayed hypersensitivity reactions 5.
- It's crucial to assess the patient's allergy history and consider penicillin skin testing to determine the best course of treatment 6, 5.
- Other alternatives for treating soft tissue infections in patients with penicillin allergy include lincosamides (clindamycin, lincomycin) or cotrimoxazole for less serious non-multiresistant MRSA infections 3.