What is the best antibiotic for a skin tear?

Best Antibiotic for Skin Tear

For a simple skin tear, cephalexin (250-500 mg orally four times daily) is the recommended first-line antibiotic treatment due to its effectiveness against the most common causative organisms (Staphylococcus aureus and Streptococcus species). 1, 2

Initial Assessment and Classification

• Skin tears should be assessed for severity, presence of purulence, and signs of systemic infection (fever, tachycardia, tachypnea, or abnormal white blood cell count) 1
• Non-purulent skin tears are typically caused by streptococcal species, while purulent infections are more likely to be staphylococcal in origin 1
• Consider recent activities, trauma history, water contact, and animal or human bites which may suggest alternative causative organisms 1

First-Line Treatment Options

For Non-Purulent Skin Tears (Likely Streptococcal):

• Penicillin is the treatment of choice for erysipelas (a specific type of non-purulent infection) 1
• For typical cellulitis or skin tears:
  • Cephalexin 250-500 mg orally four times daily for adults 1, 2
  • Pediatric dosing: 25-50 mg/kg/day divided into four doses 2
  • Duration: 7-10 days depending on clinical response 1

For Purulent Skin Tears (Likely Staphylococcal):

• Drainage is the primary treatment for abscesses 1
• Antibiotic therapy should include:
  • Dicloxacillin 500 mg orally four times daily 1
  • Cephalexin 500 mg orally four times daily 1, 3
  • Clindamycin 300-450 mg orally four times daily (for penicillin-allergic patients) 1, 4

Alternative Options Based on Clinical Presentation

For MRSA Suspected or Confirmed:

• Trimethoprim-sulfamethoxazole 1-2 double-strength tablets twice daily 1
• Doxycycline 100 mg orally twice daily 1
• Clindamycin 300-450 mg orally four times daily 1
• Linezolid 600 mg orally twice daily (for severe infections) 1

For Severe Infections Requiring IV Therapy:

• Vancomycin 30 mg/kg/day in 2 divided doses IV 1
• Ceftaroline 600 mg IV twice daily 1, 5
• Daptomycin 4 mg/kg IV once daily 1
• Linezolid 600 mg IV every 12 hours 1

Special Considerations

• For diabetic patients or immunocompromised hosts, broader coverage may be needed 1
• For skin tears with significant contamination (soil, water exposure), consider adding coverage for gram-negative organisms 1
• Topical antibiotics like bacitracin may be sufficient for very superficial, minor skin tears without signs of spreading infection 6
• Twice-daily dosing regimens (when available) may improve patient compliance compared to four-times-daily regimens 7

Common Pitfalls to Avoid

• Failing to obtain appropriate cultures in patients with severe infection, immunocompromised status, or unusual exposures 1
• Overtreatment of minor skin tears with broad-spectrum antibiotics when local wound care alone may be sufficient 8
• Not considering MRSA coverage in patients with risk factors (prior MRSA infection, healthcare exposure, injection drug use) 1
• Inadequate duration of therapy leading to treatment failure or recurrence 1

In conclusion, cephalexin remains the most appropriate first-line antibiotic for typical skin tears due to its proven efficacy against both streptococcal and staphylococcal infections, good safety profile, and cost-effectiveness. For patients with penicillin allergies or suspected MRSA, clindamycin or trimethoprim-sulfamethoxazole are reasonable alternatives.