From the Guidelines
For skin infections when Keflex (cephalexin) isn't an option, Clindamycin (300-450mg orally every 6-8 hours for 7-10 days) is a recommended alternative, particularly for MRSA infections, as suggested by the Infectious Diseases Society of America guidelines 1. When considering alternatives to Keflex for skin infections, several factors come into play, including the severity of the infection, patient allergies, and local resistance patterns.
- Clindamycin is effective against a wide range of bacteria, including MRSA, and is often prescribed for skin and soft tissue infections.
- Trimethoprim-sulfamethoxazole (TMP-SMX, one double-strength tablet twice daily for 7-10 days) is another option that works well against MRSA and other common skin pathogens.
- Doxycycline (100mg twice daily for 7-10 days) provides good coverage for many skin infections and is a suitable alternative for patients who are allergic to penicillin or cephalosporins.
- For more severe infections, fluoroquinolones like levofloxacin (500mg daily) may be used, though resistance concerns exist and should be considered when making treatment decisions.
- Amoxicillin-clavulanate (875/125mg twice daily for 7-10 days) offers broad coverage, including beta-lactamase producing bacteria, making it a viable option for skin infections when Keflex is not suitable. It's essential to complete the full course of antibiotics, even if symptoms improve quickly, and to consult a healthcare provider if the infection worsens or doesn't improve within 48-72 hours of treatment, as indicated by the guidelines 1.
From the Research
Alternative Antibiotics to Keflex for Skin Infections
- Cephalexin is an effective alternative to Keflex for the treatment of skin infections, with cure rates of 90% or higher 2.
- Augmentin, a combination of amoxycillin and clavulanic acid, is also a useful antibiotic for the treatment of skin infections, with a response rate of 94% 3.
- Cefdinir is another option, with clinical cure rates of 89% for mild to moderate uncomplicated skin and skin structure infections 4.
- For impetigo, topical antibiotics such as mupirocin, retapamulin, and fusidic acid are recommended, while oral antibiotics like amoxicillin/clavulanate, dicloxacillin, cephalexin, and clindamycin can be used for more severe cases 5.
- In patients with atopic dermatitis, cephalexin is a preferred first-line antibiotic due to its restricted antimicrobial spectrum and limited resistance 6.
Considerations for Antibiotic Resistance
- The increasing prevalence of antibiotic-resistant bacteria, including methicillin-resistant Staphylococcus aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus, should be considered when choosing an antibiotic 5.
- Antimicrobial susceptibility testing can help guide antibiotic selection, as seen in a study where all Staphylococcus aureus strains were susceptible to vancomycin 6.