From the Guidelines
For post-operative surgical skin infections, the first-line oral antibiotic treatment is typically a first-generation cephalosporin, such as cephalexin (Keflex) 500 mg four times daily for 5-7 days, as recommended by the Infectious Diseases Society of America 1. When considering the treatment of surgical skin infections, it is essential to take into account the severity of the infection and the presence of systemic signs of infection, such as erythema and induration extending >5 cm from the wound edge, temperature >38.5°C, heart rate >110 beats/minute, or white blood cell (WBC) count >12 000/µL 1. Some key points to consider when selecting an antibiotic include:
- The type of surgery and the location of the surgical site, as infections following operations on the axilla, gastrointestinal (GI) tract, perineum, or female genital tract may require agents active against gram-negative bacteria and anaerobes, such as a cephalosporin or fluoroquinolone in combination with metronidazole 1.
- The presence of risk factors for MRSA, such as nasal colonization, prior MRSA infection, recent hospitalization, or recent antibiotics, which may necessitate the use of vancomycin, linezolid, daptomycin, telavancin, or ceftaroline 1.
- The importance of adequate wound care, including gentle cleaning and appropriate dressing changes, alongside antibiotic therapy. It is crucial to note that the choice of antibiotic should be guided by local resistance patterns, severity of infection, and patient factors like allergies and kidney function, and that treatment should begin promptly after diagnosis, with patients completing the full course even if symptoms improve quickly 1.
From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylocci... Serious skin and soft tissue infections The best antibiotic for surgical skin infection post-operative by mouth is clindamycin (PO), as it is indicated for the treatment of serious skin and soft tissue infections, including those caused by susceptible strains of streptococci, staphylococci, and anaerobic bacteria 2.
- Key points:
- Clindamycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria
- Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin
- Local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy in the absence of culture and susceptibility data
From the Research
Antibiotic Options for Surgical Skin Infections
- The most common causes of surgical skin infections are Staphylococcus aureus and Streptococcus pyogenes 3.
- For the treatment of complicated skin and soft tissue infections, including surgical site infections, antibiotics such as vancomycin or daptomycin are recommended as initial treatment, with adjustments made based on antibiotic susceptibility results 4.
- For methicillin-susceptible Staphylococcus aureus (MSSA), cefazolin or antistaphylococcal penicillins are recommended, while vancomycin, daptomycin, or ceftobiprole are recommended for methicillin-resistant Staphylococcus aureus (MRSA) 4.
Prevention of Surgical Site Infections
- Strategies to prevent surgical site infections include avoiding razors for hair removal, decolonization with intranasal antistaphylococcal agents and antistaphylococcal skin antiseptics, use of chlorhexidine gluconate and alcohol-based skin preparation, maintaining normothermia, perioperative glycemic control, and use of negative pressure wound therapy 5.
- Appropriate dosing, timing, and choice of preoperative parenteral antimicrobial prophylaxis are also crucial in preventing surgical site infections 5.
Oral Antibiotic Treatment
- While the provided studies do not specifically address oral antibiotic treatment for surgical skin infections, they do emphasize the importance of appropriate antibiotic treatment based on the causative organism and its susceptibility pattern 3, 6, 4.
- It is essential to note that the choice of antibiotic should be guided by the results of culture and susceptibility testing, as well as local antimicrobial resistance patterns 4.