What are the appropriate antibiotics (ABx) for treating a wound infection?

From the Guidelines

For wound infections, empiric antibiotic therapy should be started promptly based on the severity and type of infection, with consideration of the likely etiologic agent(s) and local resistance patterns, as recommended by the Infectious Diseases Society of America 1.

Key Considerations

• The decision to start antibiotic therapy should be based on the presence of clinical evidence of infection, and the severity of the infection should guide the selection of the antibiotic regimen.
• For mild to moderate infections, oral options such as dicloxacillin, cephalexin, or clindamycin may be sufficient, while more severe infections may require intravenous options like cefazolin, nafcillin/oxacillin, or vancomycin if MRSA is suspected.
• The duration of antibiotic therapy should be individualized based on the patient's clinical response, but typically ranges from 5-14 days.
• Wound care, including cleaning, debridement, and incision and drainage for abscesses, is equally important as antibiotic therapy.
• The selection of antibiotics should cover common skin pathogens like Staphylococcus aureus and Streptococcus species, with broader coverage for diabetic, polymicrobial, or healthcare-associated infections.

Empiric Antibiotic Regimens

• For mild to moderate infections, consider oral options like clindamycin 300-450mg three times daily, or dicloxacillin 500mg four times daily, for 5-7 days.
• For more severe infections, consider intravenous options like cefazolin 1-2g every 8 hours, or vancomycin 15-20mg/kg every 8-12 hours, if MRSA is suspected.

Important Principles

• Obtain wound cultures when possible to guide targeted therapy.
• Reassess the patient within 48-72 hours to evaluate treatment response and narrow therapy based on culture results when available.
• Consider the risk of MRSA and other resistant organisms when selecting an empiric antibiotic regimen, as recommended by the Infectious Diseases Society of America 1.

From the FDA Drug Label

1. 3 Skin and Skin Structure Infections Piperacillin and Tazobactam for Injection is indicated in adults for the treatment of uncomplicated and complicated skin and skin structure infections, including cellulitis, cutaneous abscesses and ischemic/diabetic foot infections caused by beta-lactamase producing isolates of Staphylococcus aureus. The answer is piperacillin-tazobactam (IV) for wound infection, specifically for complicated skin and skin structure infections, including those caused by beta-lactamase producing isolates of Staphylococcus aureus 2.

• Key points:
  • Piperacillin-tazobactam is indicated for skin and skin structure infections
  • It is effective against beta-lactamase producing isolates of Staphylococcus aureus
  • The usual duration of treatment is from 7 to 10 days 2

From the Research

Antibiotic Treatment for Wound Infections

• The choice of antibiotic for wound infections depends on the causative organism and its susceptibility pattern.
• According to 3, cotrimoxazole and clindamycin are effective against skin and soft tissue infections (SSTIs) caused by Staphylococcus aureus and streptococci.
• Cotrimoxazole has preserved activity against methicillin-susceptible and methicillin-resistant S. aureus (MRSA) and streptococci, while clindamycin has good activity against methicillin-susceptible S. aureus, but its effectiveness against MRSA is limited due to growing resistance 3.
• Another study 4 found that clindamycin's activity against community-associated MRSA with inducible resistance is impacted by inoculum size, and alternative treatments such as daptomycin and vancomycin may be more effective.
• Vancomycin has been shown to be an effective prophylactic agent against staphylococcal wound infections, including those caused by MRSA 5.
• Fluoroquinolones such as ciprofloxacin and ofloxacin may also be effective against staphylococcal wound infections, but their use should be considered in the context of potential resistance patterns 5.

Considerations for Antibiotic Choice

• The choice of antibiotic should be guided by the results of susceptibility testing and the severity of the infection.
• The potential for resistance development and the impact on antibiotic resistance patterns should also be considered.
• Combination therapy or alternative treatments may be necessary in cases of complex or resistant infections 4.