From the Guidelines
Antibiotic treatment is not generally recommended for skin injuries, but may be necessary in certain cases, such as when there are systemic signs of infection, compromised immune status, severe comorbidities, associated severe cellulitis, or severe and deep wounds 1.
Recommendations for Antibiotic Treatment
- Irrigation of the wound and debridement of necrotic tissue are the most important factors in preventing infection and can substantially decrease the incidence of invasive wound infection 1.
- For patients with systemic signs of infection, compromised immune status, severe comorbidities, associated severe cellulitis, severe and deep wounds, a broad-spectrum antibiotic effective against aerobic and anaerobic organisms is always required 1.
- Incision and drainage is the main treatment for cutaneous abscesses, and antibiotics may not provide any additional benefit, but may be recommended in certain cases, such as when there are signs of systemic illness or rapid progression of the infection 1.
- Oral antibiotics that may be used as empirical therapy for skin and soft-tissue infections include TMP-SMX, doxycycline, clindamycin, and linezolid 1.
Specific Antibiotic Regimens
- For purulent cellulitis, recommended treatments include clindamycin 300-450 mg PO TID, TMP-SMX 1-2 DS tab PO BID, doxycycline 100 mg PO BID, and linezolid 600 mg PO BID 1.
- For nonpurulent cellulitis, recommended treatments include b-lactam (e.g. cephalexin and dicloxacillin), clindamycin, and linezolid 1.
Special Considerations
- Prophylactic antibiotics may be considered for high-risk wounds, such as those involving the face, hand, or foot, or in patients with compromised immune status or severe comorbidities 1.
- Amoxicillin-clavulanate may be recommended for animal bites that are at high risk of infection, particularly if the patient presents more than 9 hours after the bite 1.
From the Research
Recommendations for Antibiotic Treatment
The following are recommendations for antibiotic treatment in cases of skin injuries:
- Topical antibiotics are advised to treat minor superficial uncomplicated skin infections, such as impetigo, and to prevent bacterial infections caused by minor cuts, scrapes, and burns 2.
- Local antibiotic administration is a simple method for prevention of infections in routine skin surgery 3.
- The application of a neomycin-bacitracin-polymyxin preparation reduces the incidence of staphylococcal and streptococcal infection of minor skin trauma 4.
- National guidelines suggest that most skin abscesses do not require antibiotics, and that cellulitis antibiotics should target streptococci, not community-associated MRSA (CA-MRSA) 5.
Considerations for Antibiotic Use
When considering antibiotic treatment for skin injuries, the following should be taken into account:
- Antibiotic treatment can alter the composition of the microbiota on the skin surface and influence innate immune responses 6.
- The use of antibiotics should be carefully considered in the treatment of skin injury, as it may contribute to delayed wound repair 6.
- Antibiotics were over-used for discharged abscess cases, and CA-MRSA-active antibiotics were underused among regimens when antibiotics were used for abscess 5.
Types of Antibiotics
Different types of antibiotics are effective against different species of bacteria, including:
- Retapamulin, a novel topical antibacterial agent, which may replace the use of old mupirocin and fusidic acid 2.
- Neomycin-bacitracin-polymyxin preparations, which reduce the incidence of staphylococcal and streptococcal infection of minor skin trauma 4.
- Anti-CA-MRSA agents, which are underused among regimens when antibiotics are used for abscess 5.