What are good antibiotics for skin wound coverage?

Optimal Antibiotics for Skin Wound Coverage

For skin wound coverage, amoxicillin-clavulanate (875/125 mg twice daily orally) is the preferred first-line antibiotic for most uncomplicated skin wounds due to its broad coverage against common wound pathogens including staphylococci, streptococci, and anaerobes. 1, 2

First-Line Options Based on Wound Type

Uncomplicated Wounds

• Amoxicillin-clavulanate: 875/125 mg twice daily orally for 5-6 days
• Cephalexin: 500 mg 3-4 times daily for 5-6 days (if MRSA is not suspected)

For MRSA Coverage (when suspected or confirmed)

• Clindamycin: 300-450 mg orally three times daily for 5-6 days
• Doxycycline: 100 mg twice daily for 5-6 days
• Trimethoprim-sulfamethoxazole (TMP-SMX): Consider for MRSA coverage

For Human Bite Wounds

• Amoxicillin-clavulanate: 875/125 mg twice daily (preferred)
• Ampicillin-sulbactam: 1.5-3.0 g every 6 hours (IV option)
• Alternative for penicillin allergy: Fluoroquinolone (e.g., ciprofloxacin or levofloxacin) plus metronidazole, or moxifloxacin as single agent 1

Treatment Duration

• Standard treatment for uncomplicated wounds: 5-7 days
• More severe infections or slow clinical response: 10-14 days
• Continue treatment until patient is afebrile and asymptomatic for at least 48 hours 2

Special Considerations

Tetanus Prophylaxis

• Administer tetanus toxoid to patients without vaccination within 10 years
• Tetanus, diphtheria, and pertussis (Tdap) is preferred over Tetanus and diphtheria (Td) if not previously given 1

Wound Management

• Primary wound closure not recommended except for facial wounds
• Facial wounds should receive copious irrigation, cautious debridement, and preemptive antibiotics
• Other wounds may be approximated but not fully closed 1

Important Precautions and Contraindications

• Doxycycline: Avoid in children under 8 years (risk of tooth discoloration) and pregnant women in third trimester 2
• Amoxicillin-clavulanate: Take with meals to reduce GI upset; monitor for allergic reactions (penicillin class) 3
• Clindamycin: Carries risk of Clostridioides difficile infection 2

Monitoring and Follow-up

• Reassess within 48-72 hours to ensure clinical improvement
• Consider broadening antibiotic coverage if no improvement
• Evaluate for possible abscess requiring drainage
• Consider underlying conditions affecting treatment response 2

Common Pitfalls to Avoid

1. Failing to consider local resistance patterns when selecting empiric therapy
2. Not providing adequate duration of therapy for deep-seated infections
3. Overlooking the possibility of an abscess requiring drainage
4. Not completing the full course of antibiotics, which may decrease effectiveness and increase bacterial resistance 2, 3
5. Delaying removal of jewelry in infected piercings, which can impede drainage 2

Remember that antibiotics should be used only for bacterial infections, not viral infections, and the full course should be completed even if symptoms improve early to prevent resistance development 3.