From the Guidelines
For soft tissue infections, empiric antibiotic therapy should typically include coverage for Staphylococcus aureus and Streptococcus species, with clindamycin, trimethoprim-sulfamethoxazole (TMP-SMX), doxycycline, and linezolid being recommended options for outpatient treatment of purulent cellulitis due to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) 1.
Key Considerations
- Incision and drainage is the primary treatment for cutaneous abscesses, with antibiotic therapy recommended for abscesses associated with severe or extensive disease, systemic illness, comorbidities, or lack of response to incision and drainage alone 1.
- For outpatients with purulent cellulitis, empirical therapy for CA-MRSA is recommended pending culture results, with options including clindamycin, TMP-SMX, doxycycline, and linezolid 1.
- For outpatients with nonpurulent cellulitis, empirical therapy for infection due to b-hemolytic streptococci is recommended, with options including beta-lactam antibiotics such as cephalexin or dicloxacillin, and consideration of coverage for CA-MRSA in patients who do not respond to beta-lactam therapy or have systemic toxicity 1.
- For hospitalized patients with complicated soft tissue infections, empirical therapy for MRSA should be considered pending culture data, with options including intravenous vancomycin, linezolid, daptomycin, telavancin, and clindamycin 1.
Treatment Options
- Clindamycin: 300-450 mg orally four times daily for 5-7 days for uncomplicated infections, or 600 mg intravenously every 8 hours for more severe infections 1.
- TMP-SMX: 1-2 double-strength tablets orally twice daily for 5-7 days for uncomplicated infections 1.
- Doxycycline: 100 mg orally twice daily for 5-7 days for uncomplicated infections 1.
- Linezolid: 600 mg orally or intravenously every 12 hours for 5-7 days for uncomplicated infections, or 600 mg every 12 hours for more severe infections 1.
Duration of Treatment
- Uncomplicated infections: 5-7 days of therapy, with clinical improvement guiding the decision to discontinue therapy 1.
- More severe infections: 10-14 days of therapy, with clinical improvement guiding the decision to discontinue therapy 1.
From the Research
Recommended Antibiotics for Soft Tissue Infections
- For methicillin-susceptible S. aureus (MSSA) infections, penicillinase-resistant penicillins (flucloxacillin, dicloxacillin) are the antibiotics of choice, while first generation cephalosporins (cefazolin, cephalothin and cephalexin), clindamycin, lincomycin and erythromycin have important therapeutic roles in less serious MSSA infections such as skin and soft tissue infections 2.
- For less serious non-multiresistant MRSA (nmMRSA) infections, lincosamides (clindamycin, lincomycin) or cotrimoxazole are the antibiotics of choice 2.
- Cephalexin is a suitable option for the treatment of mild to moderate soft tissue infections, with clinical response rates exceeding 95% 3.
- Clindamycin is a safe and effective agent in the treatment of skin and soft-tissue infections, with cure rates comparable to those of cloxacillin 4.
- Current guidelines recommend using new antimicrobials and shorter antibiotic treatment courses, with a focus on stewardship programmes and collaborative management 5.
Specific Antibiotic Options
- Penicillinase-resistant penicillins: flucloxacillin, dicloxacillin 2
- First generation cephalosporins: cefazolin, cephalothin, cephalexin 2
- Lincosamides: clindamycin, lincomycin 2, 4
- Cotrimoxazole 2
- Cephalexin 3
- Clindamycin 4
- Vancomycin or teicoplanin for serious MRSA infections 2
- Rifampicin and fusidic acid for multiresistant MRSA (mrMRSA) infections 2
- Linezolid and quinupristin/dalfopristin for highly resistant strains or patients who fail on or are intolerant of conventional therapy 2