What antibiotics are recommended for superficial skin infections at intravenous (IV) injection sites?

From the Guidelines

For superficial skin infections at intravenous (IV) injection sites, I recommend starting with empiric broad-spectrum antibiotic therapy that covers Gram-positive, Gram-negative, and anaerobic bacteria, as suggested by the 2018 WSES/SIS-E consensus conference 1.

Key Considerations

• The choice of antibiotic should be based on the severity of the infection and the presence of systemic signs of infection.
• For patients with systemic signs of infection, immunocompromised patients, or those with incomplete source control, antibiotic therapy is recommended.
• The recommended antibiotic regimen should cover common causes of skin infections, including Staphylococcus and Streptococcus.

Antibiotic Options

• Cephalexin 500mg four times daily for 7-10 days or dicloxacillin 500mg four times daily for 7-10 days are good first-line options for mild to moderate infections, as they target Staphylococcus and Streptococcus 1.
• If MRSA is suspected or prevalent in the area, consider trimethoprim-sulfamethoxazole (Bactrim DS) one tablet twice daily for 7-10 days or clindamycin 300-450mg four times daily for 7-10 days 1.
• For more severe infections or those with significant cellulitis, vancomycin or another antimicrobial effective against both MRSA and streptococci may be recommended 1.

Additional Recommendations

• Keep the area clean by washing gently with soap and water daily, and consider covering with a sterile bandage if draining.
• Warm compresses applied for 15 minutes several times daily can help improve blood flow to the area and speed healing.
• The duration of antimicrobial therapy should be 5 days, but treatment should be extended if the infection has not improved within this time period 1.

From the Research

Antibiotic Treatment for Superficial Skin Infections

The following antibiotics are recommended for superficial skin infections at intravenous (IV) injection sites:

• Amoxicillin + clavulanate as the first-line antibiotic in most children suffering from severe skin infections requiring antibiotic treatment 2
• Clindamycin should be considered in patients presenting toxinic symptoms and signs 2
• Topical antibiotics such as mupirocin, retapamulin, and fusidic acid for impetigo 3
• Oral antibiotic therapy can be used for impetigo with large bullae or when topical therapy is impractical, with options including amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides 3

Factors Associated with Persistent Infection

The following factors are associated with persistent infection despite antibiotic treatment for superficial surgical site infections:

• Superficial SSIs diagnosed later in follow-up were associated with antibiotics not resolving the SSI 4
• Time from injury to initial surgical irrigation and débridement 4

Treatment of Superficial Surgical Site Infections

The following treatments are recommended for superficial surgical site infections:

• Antibiotics alone can be an appropriate treatment option when treating superficial SSIs after an open fracture wound, especially when promptly diagnosed 4
• Local wound care and oral antibiotic therapy for superficial SSI 5
• Topical antibiotic use for impetigo 6
• Antiseptic treatment for impetigo 6