Treatment of Superficial Wound Skin Infections
The primary treatment for superficial wound skin infections depends on the type of infection: antibiotics against Gram-positive bacteria for spreading infections like impetigo, erysipelas, and cellulitis; and incision and drainage for well-circumscribed abscesses or boils. 1
Types of Superficial Wound Infections and Their Management
Spreading Infections (Impetigo, Erysipelas, Cellulitis)
- These infections present with erythema, tenderness, and induration and are primarily caused by Gram-positive bacteria, particularly streptococci and S. aureus 1
- Treatment should include antibiotics targeting Gram-positive bacteria 1
- For mild-to-moderate infections in patients without recent antibiotic exposure, therapy aimed solely at aerobic gram-positive cocci is usually sufficient 1
- Consider empiric therapy for community-acquired MRSA (CA-MRSA) for patients at risk or who don't respond to first-line therapy 1
Superficial Abscesses
- Incision and drainage is the cornerstone of treatment for simple abscesses or boils 1, 2
- Complete evacuation of all purulent material is essential 2
- After drainage, wounds should be left open to heal by secondary intention with regular dressing changes 2
- Antibiotics are generally unnecessary for uncomplicated abscesses after adequate drainage 1, 2
Superficial Surgical Site Infections (SSIs)
- Superficial incisional SSIs that have been opened can usually be managed without antibiotics 1
- Drainage, irrigation, and if needed, debridement are the primary treatments 1
Antibiotic Selection and Administration
When to Use Antibiotics
- For spreading infections (impetigo, erysipelas, cellulitis) 1
- For incisional SSIs with systemic inflammatory response, signs of organ failure, or in immunocompromised patients 1
- For abscesses with extensive surrounding cellulitis, systemic symptoms, or in immunocompromised patients 2
Route of Administration
- Highly bioavailable oral antibiotics can be used for most mild and many moderate infections 1
- Parenteral therapy is required for virtually all severe and some moderate infections, at least initially 1
- Topical therapy may be used for some mild superficial infections 1, 3
Duration of Therapy
- For mild infections: 1-2 weeks usually suffices, but some require an additional 1-2 weeks 1
- For moderate and severe infections: usually 2-4 weeks depending on structures involved, adequacy of debridement, and wound vascularity 1
Wound Care
General Principles
- Proper wound cleansing, debridement of any callus and necrotic tissue, and off-loading of pressure are crucial for healing 1
- For abscesses after drainage:
Topical Antimicrobials
- For adults and children over 2 years: clean the affected area and apply a small amount of topical antimicrobial 1-3 times daily; may be covered with a sterile bandage 3
- Topical antibiotics have lower incidence of systemic toxicity, secondary effects, and development of resistance compared to systemic antibiotics 4
Special Considerations
Diabetic Foot Infections
- Select empirical antibiotic regimen based on infection severity and likely pathogens 1
- Provide optimal wound care in addition to appropriate antibiotic treatment 1
- Early surgical consultation for deep abscess, extensive bone/joint involvement, or substantial necrosis/gangrene 1
Animal Bites
- Use antimicrobial agents active against both aerobic and anaerobic bacteria, such as amoxicillin-clavulanate 1
- Primary wound closure is generally not recommended except for facial wounds 1
Follow-up Recommendations
- Routine follow-up within 48-72 hours to assess wound healing 2
- Patients should return sooner if they develop increasing pain, swelling, redness, fever, systemic symptoms, or if symptoms fail to improve within 48 hours 2