What is the treatment for an infection?

Treatment of Infections

The appropriate treatment for an infection requires prescribing antibiotic therapy targeted at the likely causative pathogens based on the type and severity of infection, while ensuring appropriate wound care when applicable. 1

General Principles of Infection Treatment

• All clinically infected wounds should receive antibiotic therapy, but this alone is often insufficient without appropriate wound care 1
• Clinically uninfected wounds should not be treated with antibiotics 1
• Selection of empiric antibiotic regimen should be based on:
  • Severity of infection (mild, moderate, severe) 1
  • Likely causative pathogens 1
  • Local epidemiology and resistance patterns 1
  • Patient's prior antibiotic exposure 1

Treatment Algorithm Based on Infection Severity

Mild Infections

• For mild to moderate infections in patients without recent antibiotic exposure:
  • Target therapy at aerobic gram-positive cocci (GPC) 1
  • Consider oral antibiotics with high bioavailability 1
  • Typical duration: 1-2 weeks 1
  • Examples include impetigo, erysipelas, and mild cellulitis 1

Moderate Infections

• For moderate infections:
  • Consider broader coverage if risk factors present 1
  • May require initial parenteral therapy with switch to oral agents when patient improves clinically 1
  • Typical duration: 2-3 weeks 1
  • Consider hospitalization for patients with complicating features (e.g., severe peripheral arterial disease) 1

Severe Infections

• For severe infections:
  • Start broad-spectrum empiric antibiotic therapy pending culture results 1
  • Use parenteral route initially 1
  • Consider hospitalization 1
  • Typical duration: 2-3 weeks 1

Special Considerations for Specific Pathogens

• MRSA coverage should be considered when:

  • Patient has prior history of MRSA infection 1
  • Local prevalence of MRSA is high 1
  • Infection is clinically severe 1

• Pseudomonas aeruginosa coverage is usually unnecessary except for patients with specific risk factors 1

• For fungal infections in immunocompromised patients:

  • Consider antifungal prophylaxis for patients with prolonged neutropenia, history of fungal infections, or recent prolonged treatment with high-dose corticosteroids 1
  • If prophylaxis is needed, fluconazole is recommended 1

Diagnostic Approach

• For infected wounds, obtain appropriate specimens for culture prior to starting empiric antibiotic therapy 1

  • Deep tissue specimens obtained by biopsy or curettage after wound cleansing and debridement are preferred 1
  • Avoid swab specimens, especially from inadequately debrided wounds 1

• For clinically uninfected wounds, cultures are not recommended 1

Definitive Therapy

• Base definitive therapy on:

  • Results of appropriately obtained cultures and sensitivity testing 1
  • Patient's clinical response to the empiric regimen 1

• Continue antibiotic therapy until resolution of infection findings, but not through complete wound healing 1

Common Pitfalls to Avoid

• Treating colonization rather than infection 1
• Using unnecessarily broad-spectrum antibiotics 1
• Continuing antibiotics beyond resolution of infection 1
• Failing to obtain appropriate cultures before starting antibiotics 1
• Relying solely on antibiotic therapy without addressing necessary wound care 1

Special Populations

• For immunocompromised patients:

  • Consider early dermatology consultation 1
  • Consider early biopsy and surgical debridement 1
  • Empiric antibiotics, antifungals, and/or antivirals should be considered in life-threatening situations 1

• For diabetic foot infections:

  • All infected wounds require antibiotic therapy 1
  • Selection of antibiotic regimen should be based on infection severity and likely pathogens 1
  • Definitive therapy should follow principles of antibiotic stewardship 1

By following these evidence-based guidelines, most infections can be effectively treated while minimizing unnecessary antibiotic use and the development of antimicrobial resistance.