What are the intravenous (IV) treatment options for skin infections?

From the Guidelines

Intravenous (IV) treatment options for skin infections include vancomycin, linezolid, daptomycin, and ceftaroline, as these antibiotics have been shown to be effective against methicillin-resistant Staphylococcus aureus (MRSA) and other common causes of skin infections 1.

First-line IV treatment options

• Vancomycin: 30 mg/kg/d in 2 divided doses IV, with a maximum adult daily dose 1
• Linezolid: 600 mg every 12 hours IV 1
• Daptomycin: 10 mg/kg/dose IV once daily 1
• Ceftaroline: IV dose not specified in the provided evidence, but recommended as an option for MRSA skin and soft-tissue infections 1

Additional IV treatment options

• Piperacillin-tazobactam: 3.37 g every 6-8 hours IV, for mixed infections or necrotizing fasciitis 1
• Imipenem-cilastatin: 1 g every 6-8 hours IV, for mixed infections or necrotizing fasciitis 1
• Meropenem: 1 g every 8 hours IV, for mixed infections or necrotizing fasciitis 1
• Ertapenem: 1 g daily IV, for mixed infections or necrotizing fasciitis 1
• Clindamycin: 600-900 mg every 8 hours IV, for streptococcal or staphylococcal infections, including MRSA 1
• Nafcillin or oxacillin: 1-2 g every 4 hours IV, for staphylococcal infections, including MRSA 1
• Cefazolin: 1 g every 8 hours IV, for staphylococcal infections, including MRSA 1 It is essential to note that the choice of antibiotic should be guided by the severity of the infection, the suspected or confirmed causative pathogen, and local resistance patterns. Additionally, the duration of therapy should be individualized based on the patient's clinical response, typically ranging from 7 to 14 days 1.

From the Research

Intravenous Treatment Options for Skin Infections

The following are intravenous (IV) treatment options for skin infections:

• Dalbavancin, a long-acting IV antibiotic, has been shown to reduce hospitalization rates for patients with skin and soft tissue infections (SSTIs) 2, 3
• Omadacycline and linezolid are also available as IV formulations for the treatment of acute bacterial skin and skin structure infections (ABSSSI) 4
• IV antibiotics such as dalbavancin, omadacycline, and linezolid can be used to treat various skin infections, including cellulitis, abscess, and wound infections 2, 5, 3, 4

Specific IV Treatment Regimens

Some specific IV treatment regimens for skin infections include:

• A single dose of dalbavancin (1500 mg) as an alternative to a 2-dose regimen for the treatment of ABSSSI 3
• IV omadacycline or linezolid as initial therapy, with optional switch to oral therapy, for the treatment of ABSSSI 4

Considerations for IV Treatment

When considering IV treatment for skin infections, the following factors should be taken into account:

• The severity of the infection and the need for hospitalization 2, 6
• The presence of drug-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) 5, 3
• The potential for early switch to oral therapy and discharge from the hospital 4, 6