What is the treatment for soft tissue infection of the skin?

From the Guidelines

The primary treatment for soft tissue infections of the skin is incision and drainage, with antibiotic therapy recommended for abscesses associated with severe or extensive disease, systemic illness, or other specific conditions, as outlined in the guidelines by the Infectious Diseases Society of America 1. The treatment approach for soft tissue infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA), involves a combination of surgical intervention and antibiotic therapy. For mild infections, oral antibiotics such as clindamycin, trimethoprim-sulfamethoxazole (TMP-SMX), doxycycline, or linezolid may be effective, with the choice of antibiotic depending on the severity of the infection, suspected pathogens, patient allergies, and local resistance patterns 1. Some key points to consider in the treatment of soft tissue infections include:

• Incision and drainage is the primary treatment for cutaneous abscesses, with antibiotic therapy recommended for abscesses associated with severe or extensive disease, systemic illness, or other specific conditions 1.
• Oral antibiotics such as clindamycin, TMP-SMX, doxycycline, or linezolid may be effective for mild infections, with the choice of antibiotic depending on the severity of the infection, suspected pathogens, patient allergies, and local resistance patterns 1.
• For more severe infections, intravenous antibiotics such as vancomycin, daptomycin, or linezolid may be necessary, with the choice of antibiotic depending on the severity of the infection, suspected pathogens, patient allergies, and local resistance patterns 1.
• Supportive care, including elevation of the affected area, warm compresses, and proper wound care with regular cleaning and dressing changes, is also important in the treatment of soft tissue infections.
• It is essential to complete the full course of antibiotics even if symptoms improve quickly to prevent recurrence and antibiotic resistance.
• Patients should seek immediate medical attention if they develop fever, increasing pain, rapid spread of redness, or red streaking from the infection site, as these may indicate a worsening infection requiring more aggressive treatment.

From the FDA Drug Label

1. 3 Skin and Skin Structure Infections Piperacillin and Tazobactam for Injection is indicated in adults for the treatment of uncomplicated and complicated skin and skin structure infections, including cellulitis, cutaneous abscesses and ischemic/diabetic foot infections caused by beta-lactamase producing isolates of Staphylococcus aureus. The treatment for soft tissue infection of the skin is piperacillin-tazobactam (IV), specifically for uncomplicated and complicated skin and skin structure infections, including cellulitis, cutaneous abscesses, and ischemic/diabetic foot infections caused by beta-lactamase producing isolates of Staphylococcus aureus 2.

• The usual total daily dosage is 3.375 grams every six hours [totaling 13.5 grams (12.0 grams piperacillin and 1.5 grams tazobactam)].
• The usual duration of treatment is from 7 to 10 days.

From the Research

Treatment Options for Soft Tissue Infections

• Beta-lactam antibiotics are highly effective against most bacteria causing skin and soft tissue infections, with good tissue penetration making them useful for treatment 3
• Drugs with a narrow spectrum should be among the first choice, with broader spectrum beta-lactam antibiotics used in cases of reduced bacterial susceptibility 3
• Other oral antibacterial agents, such as clindamycin and metronidazole, may be used in cases of easy and moderately severe anaerobic infections not treatable with conventional oral beta-lactam antibiotics 3

Antibiotic Administration

• Beta-lactam antibiotics do not need to be administered more than 2 or 3 times a day due to their long duration of skin and soft tissue levels 3
• Normal dosage schedules can be employed, except in cases of severely compromised elimination or immuno-compromised hosts, where decreased or increased doses may be recommended 3

Management of Skin and Soft Tissue Infections

• New guidelines have become available to better define skin and soft tissue infections and their response to antimicrobial treatment, with a focus on optimizing treatment to avoid prolonged hospitalizations and extra costs 4
• Early assessment of patient's clinical conditions and response to treatment can facilitate patients' discharge, with new therapeutic options offering efficacy against drug-resistant Gram-positive bacteria 4
• Current international and national guidelines recommend using new antimicrobials and prescribing shorter antibiotic treatment courses, with a focus on refining appropriate drug decision-making 5

Specific Treatment Recommendations

• Amoxicillin + clavulanate is recommended as the first-line antibiotic in most children suffering from severe skin infections requiring antibiotic treatment, with clindamycin considered for patients presenting toxinic symptoms and signs 6
• Oral antimicrobial options are available for treating skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in the community, with evidence supporting their use 7