From the Guidelines
For surgical skin infections, the best antibiotic is typically a first-generation cephalosporin, such as cefazolin, or an antistaphylococcal penicillin for methicillin-susceptible Staphylococcus aureus (MSSA). According to the 2014 update by the Infectious Diseases Society of America 1, a first-generation cephalosporin or an antistaphylococcal penicillin is recommended for MSSA.
- Key considerations for antibiotic selection include:
- The severity of the infection
- The presence of systemic signs of infection
- The risk factors for methicillin-resistant Staphylococcus aureus (MRSA)
- The location of the surgical site
- For patients with risk factors for MRSA, such as nasal colonization, prior MRSA infection, recent hospitalization, or recent antibiotics, vancomycin, linezolid, daptomycin, telavancin, or ceftaroline may be considered 1.
- In addition to antibiotic therapy, proper wound care, including incision and drainage, debridement of necrotic tissue, and appropriate dressing changes, is essential for the management of surgical skin infections 1.
- The duration of antibiotic therapy should be tailored based on the severity of the infection and the patient's response to treatment, with a brief course of systemic antimicrobial therapy indicated in patients with surgical site infections following clean operations on the trunk, head and neck, or extremities that also have systemic signs of infection 1.
From the FDA Drug Label
Skin and Skin Structure Infections: Due to S. aureus (including beta-lactamase-producing strains), S. pyogenes, and other strains of streptococci. Perioperative Prophylaxis: The prophylactic administration of Cefazolin for Injection, USP preoperatively, intraoperatively, and postoperatively may reduce the incidence of certain postoperative infections in patients undergoing surgical procedures which are classified as contaminated or potentially contaminated
The best antibiotic for surgical skin infection is Cefazolin. It is effective against S. aureus and S. pyogenes, which are common causes of skin and skin structure infections. Cefazolin can be used for perioperative prophylaxis to reduce the incidence of postoperative infections in surgical procedures classified as contaminated or potentially contaminated 2. The recommended dose for perioperative prophylactic use is 1 gram IV or IM administered 1/2 hour to 1 hour prior to the start of surgery 2.
From the Research
Antibiotic Options for Surgical Skin Infection
- Cephalosporins are considered the drug of choice for surgical prophylaxis due to their effectiveness and lower risk of allergic reactions 3.
- First-generation cephalosporins, such as cefazolin, are widely recommended and have been shown to be effective in preventing surgical site infections 3, 4.
- Second-generation cephalosporins, such as cefuroxime, may have a broader antimicrobial spectrum, but their effectiveness in preventing surgical site infections is similar to that of first-generation cephalosporins 4.
- Third-generation cephalosporins are not generally recommended for surgical prophylaxis, but may be used in certain cases 3.
Treatment of Specific Infections
- For Staphylococcus aureus bacteremia, initial treatment typically includes antibiotics active against MRSA, such as vancomycin or daptomycin, with adjustment based on antibiotic susceptibility results 5.
- Cefazolin or antistaphylococcal penicillins may be used to treat MSSA, while vancomycin, daptomycin, or ceftobiprole may be used to treat MRSA 5.
Use of Cephalosporins in Patients with Penicillin Allergy
- Cefazolin may be safe for use in patients with a penicillin allergy, with a low risk of cross-reactivity 6, 7.
- The use of cefazolin in patients labeled as beta-lactam allergic has been associated with a decreased risk of surgical site infections without an increase in intraoperative hypersensitivity reactions 6.