What are the recommended broad spectrum antibiotics for skin infections?

Recommended Broad Spectrum Antibiotics for Skin Infections

For skin and soft tissue infections requiring broad spectrum coverage, first-line options include vancomycin plus either piperacillin-tazobactam or imipenem/meropenem for severe infections, while amoxicillin-clavulanic acid, cephalosporins with metronidazole, or clindamycin are appropriate for mild to moderate infections. 1

Classification of Skin Infections

Non-purulent Skin Infections (primarily streptococcal)

• For mild infections: Penicillin, amoxicillin, cephalexin, or clindamycin 1
• For moderate infections: Coverage for both streptococci and MSSA with cefazolin or clindamycin 1
• For severe infections: Vancomycin or another agent effective against both streptococci and MRSA 1

Purulent Skin Infections (likely staphylococcal)

• For mild infections: Incision and drainage may be sufficient without antibiotics 1
• For moderate infections: Dicloxacillin, cephalexin, clindamycin, doxycycline, or TMP-SMX 1
• For severe infections: Vancomycin, linezolid, daptomycin, or ceftaroline 1

Recommended Oral Antibiotics

First-line options:

• Amoxicillin-clavulanic acid: Effective against streptococci, MSSA, and some anaerobes 1
• Clindamycin: Active against most streptococci and staphylococci, including some MRSA 1
• Cephalexin: Effective for streptococcal and MSSA infections 1, 2
• TMP-SMX: Particularly effective for MRSA but less active against streptococci 1, 2

For MRSA coverage:

• Linezolid (600 mg twice daily): High efficacy against MRSA with excellent bioavailability 1, 3
• TMP-SMX: Effective against MRSA but limited streptococcal coverage 1
• Doxycycline or minocycline: Good options for MRSA with fewer side effects than linezolid 1
• Tedizolid: Newer option with once-daily dosing 1

Recommended Intravenous Antibiotics

For severe infections:

• Vancomycin plus piperacillin-tazobactam or imipenem/meropenem: Provides broad coverage for severe infections 1
• Daptomycin (10 mg/kg/day): Bactericidal against MRSA and other gram-positive pathogens 1
• Linezolid (600 mg twice daily): Effective against resistant gram-positive organisms 1, 3
• Ceftaroline: Active against MRSA and many gram-negative pathogens 1, 4
• Tigecycline: Broad spectrum including MRSA and anaerobes 1

For complicated polymicrobial infections:

• Ampicillin plus gentamicin plus metronidazole: Provides broad coverage including enterococci 1
• Cefotaxime or ceftriaxone plus metronidazole: Effective against most pathogens in mixed infections 1

Duration of Therapy

• For uncomplicated infections: 5-7 days is typically sufficient 1
• For complicated infections: 7-14 days, individualized based on clinical response 1, 3
• For diabetic foot infections: 10-14 days, may require longer therapy 1, 3

Special Considerations

For diabetic wound infections:

• Mild infections: Dicloxacillin, clindamycin, cephalexin, or amoxicillin-clavulanic acid 1
• Moderate to severe infections: Broad-spectrum coverage including vancomycin for MRSA risk 1, 3

For animal and human bites:

• Amoxicillin-clavulanic acid is the preferred oral agent 1
• For more severe infections: Ampicillin-sulbactam, piperacillin-tazobactam, or carbapenems 1

For recurrent abscesses:

• Obtain cultures and treat with antibiotics active against the isolated pathogen 1
• Consider 5-day decolonization regimen with intranasal mupirocin and chlorhexidine washes 1

Clinical Pearls

• Always consider surgical drainage for abscesses, as antibiotics alone may be insufficient 1
• For severe infections, obtain blood cultures before starting antibiotics 1
• Consider local resistance patterns when selecting empiric therapy 1, 5
• Switch from IV to oral therapy when clinical stability is achieved 1
• Vancomycin should be dosed appropriately based on weight and renal function to achieve therapeutic levels 1

Potential Pitfalls

• Fluoroquinolones should be avoided as first-line agents due to increasing resistance and adverse effects 1, 5
• Macrolides have increasing resistance rates, particularly for S. aureus 2
• Monotherapy with beta-lactams may be insufficient for polymicrobial infections 1
• Failure to obtain adequate source control (drainage, debridement) may lead to treatment failure regardless of antibiotic choice 1