From the Guidelines
For skin and soft tissue infections like abscesses and furuncles with oxacillin sensitivity, the first-line treatment is a beta-lactam antibiotic such as dicloxacillin (500 mg orally four times daily for 5-10 days) or cephalexin (500 mg orally four times daily for 5-10 days) as recommended by the Infectious Diseases Society of America in 2014 1.
Key Considerations
- The choice of antibiotic should be based on the severity of the infection, patient allergies, and local resistance patterns.
- Oxacillin sensitivity indicates that the infection is likely caused by methicillin-sensitive Staphylococcus aureus (MSSA), which is effectively treated with beta-lactam antibiotics.
- Incision and drainage are crucial for abscesses, as antibiotics alone may not be sufficient without removing the purulent material.
- Alternatives for patients with penicillin allergies include clindamycin (300-450 mg orally three times daily for 5-10 days) 1.
Treatment Approach
- Treatment duration depends on the severity of the infection and clinical response, with most uncomplicated infections resolving within 5-10 days of appropriate therapy.
- Patients should be advised to complete the full course of antibiotics even if symptoms improve quickly to prevent recurrence and antimicrobial resistance.
- Warm compresses can help with furuncles, and good wound care is essential for promoting healing and preventing further complications.
Antibiotic Options
- Dicloxacillin and cephalexin are preferred due to their effectiveness against MSSA and their narrower spectrum of activity, which helps minimize the risk of promoting resistance.
- Clindamycin is a viable alternative for patients allergic to penicillin but should be used with caution due to the potential for inducible resistance in MRSA strains 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; Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin Staphylococci: Serious respiratory tract infections; serious skin and soft tissue infections.
For skin and soft tissue infections, such as abscess or furuncle, with oxacillin sensitivity, the antibiotic to cover this type of infection is clindamycin. However, bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin 2.
- Key points:
- Clindamycin is indicated for serious skin and soft tissue infections.
- Staphylococci susceptibility to clindamycin should be considered.
- Bacteriologic studies are necessary to guide antibiotic therapy.
From the Research
Antibiotic Coverage for Skin Soft Tissue Infections
To cover skin soft tissue infections such as abscesses and furuncles with oxacillin sensitivity, the following antibiotics can be considered:
- Cephalexin and clindamycin are suitable options for infections caused by streptococcal species and methicillin-susceptible S aureus 3
- Parenteral cefazolin, nafcillin, or oxacillin can be used in hospitalized patients with nonpurulent cellulitis caused by streptococci and methicillin-susceptible S aureus 3
- For oral MRSA therapy, clindamycin, doxycycline, trimethoprim-sulfamethoxazole, or linezolid is appropriate 3
- Vancomycin, linezolid, daptomycin, tigecycline, telavancin, and ceftaroline fosamil are intravenous options that should be used in MRSA infections that require patient hospitalization 3
Considerations for Empiric Antimicrobial Choice
Empiric antimicrobial choice should cover Staphylococcus and Streptococcus species for simple infections 4
- For complicated infections, including suspected necrotizing fasciitis and gangrene, empiric polymicrobial antibiotic coverage is required 4
- The choice of antibiotic should also take into account the patient's comorbidities and the severity and location of the infection 4
Management of Skin and Soft Tissue Infections
The management of skin and soft tissue infections should rely on a collaborative group with experience in this disease 5