From the Guidelines
Alternative antibiotics for a 53-year-old male with a pustular wound on the left ankle and a history of Peripheral Arterial Occlusive Disease (PAOD) who has not responded to cloxacillin and clindamycin are necessary. The patient's history of PAOD and lack of response to initial antibiotics suggest a more complex infection that may require broader coverage.
- Considering the severity of the infection and the likely etiologic agent(s), amoxicillin-clavulanate, ampicillin-sulbactam, or piperacillin-tazobactam could be used as alternative antibiotics 1.
- For patients with a history of MRSA infection or high local prevalence of MRSA, vancomycin, linezolid, or daptomycin may be considered 1.
- Fluoroquinolones such as ciprofloxacin or levofloxacin may also be used, especially if there is a risk of Pseudomonas aeruginosa infection 1.
- Clindamycin plus piperacillin-tazobactam or ceftriaxone plus metronidazole may be used for necrotizing fasciitis 1.
- The choice of antibiotic should be based on the severity of the infection, the likely etiologic agent(s), and the patient's clinical response to the empiric regimen 1.
- It is essential to note that antibiotic therapy is often insufficient without appropriate wound care, and the patient's wound should be properly cleaned, debrided, and managed to promote healing 1.
- The duration of antibiotic therapy should be based on the severity of the infection and the patient's clinical response, with a suggested initial course of 1-2 weeks for mild infections and 2-3 weeks for moderate to severe infections 1.
From the Research
Alternative Antibiotics for Treatment
Given the patient's history of Peripheral Arterial Occlusive Disease (PAOD) and lack of response to cloxacillin and clindamycin, alternative antibiotics may be considered.
- Co-trimoxazole and topical gentamicin have been shown to be effective in treating pustular acne and gram-negative folliculitis 2.
- Phytochemicals and metal nanoparticles are being investigated as alternatives to traditional antibiotics, and have been shown to be effective against a range of bacterial pathogens, including those resistant to licensed antibacterials 3.
- Roxithromycin has been studied as a potential treatment for preventing progression of peripheral arterial disease, but was found to be ineffective in a large, randomized, double-blinded, placebo-controlled trial 4.
Considerations for Treatment
When selecting an alternative antibiotic, it is essential to consider the patient's medical history and the potential for adverse reactions.
- Clindamycin has been associated with acute generalized exanthematous pustulosis (AGEP), a severe pustular cutaneous adverse drug reaction 5.
- Topical antimicrobial agents, such as cadexomer iodine or silver dressings, may be preferable to topical antibiotics, especially for malodorous or burn wounds 6.