What oral antibiotics are used to treat soft tissue infections, specifically cellulitis or abscesses, in patients with intact skin (Soft Tissue) and no signs of systemic infection?

From the Guidelines

For soft tissue skin infections, oral antibiotics such as linezolid, trimethoprim-sulfamethoxazole (TMP-SMX), a tetracycline (doxycycline or minocycline), or tedizolid are recommended as first-line treatment, with a treatment duration of 7-14 days, as suggested by the most recent guidelines 1. When considering oral antibiotic options for the management of MRSA skin and soft-tissue infections (SSTIs), it is essential to choose agents that are effective against CA-MRSA.

• Linezolid is a recommended option, with a dosage of 600 mg PO twice daily 1.
• TMP-SMX is another option, with a dosage of 1-2 DS tabs PO twice daily 1.
• A tetracycline, such as doxycycline or minocycline, can also be used, with a dosage of 100 mg PO twice daily for doxycycline and 200 mg PO three times a day, then 100 mg PO twice daily for minocycline 1.
• Tedizolid is also a recommended option, although the dosage is not specified in the guidelines 1. It is crucial to note that the choice of antibiotic should be based on the severity of the infection, the patient's clinical response, and local epidemiology.
• For patients with systemic toxicity and/or rapidly progressive or worsening infection despite receipt of appropriate oral antibiotics, inpatient management and surgical intervention may be necessary 1.
• The treatment duration should be individualized based on the patient's clinical response, but generally ranges from 7-14 days 1.
• Patients should complete the full course of antibiotics even if symptoms improve quickly, and keep the affected area clean, elevate it when possible to reduce swelling, and monitor for signs of worsening infection such as increasing redness, warmth, swelling, fever, or red streaking from the infection site. The most recent guidelines from 2018 1 provide the best evidence for the management of soft tissue skin infections, and should be followed in clinical practice.

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 staphylococci Anaerobes: Serious respiratory tract infections such as empyema, anaerobic pneumonitis, and lung abscess; serious skin and soft tissue infections; Streptococci: Serious respiratory tract infections; serious skin and soft tissue infections. Staphylococci: Serious respiratory tract infections; serious skin and soft tissue infections.

Oral Antibiotics for Soft Skin Tissue Infection:

• Clindamycin (PO) is indicated for the treatment of serious skin and soft tissue infections caused by susceptible anaerobic bacteria, streptococci, and staphylococci 2.
• Cephalexin (PO) does not have specific information in the provided label regarding its indication for soft skin tissue infections. Therefore, based on the provided information, Clindamycin (PO) can be considered for the treatment of soft skin tissue infections, but bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin 2.

From the Research

Oral Antibiotics for Soft Skin Tissue Infection

• Oral antibiotics such as clindamycin, doxycycline, and linezolid are effective in treating soft tissue infections, including those caused by Methicillin-resistant Staphylococcus aureus (MRSA) 3.
• These antibiotics offer good bioavailability and tissue penetration, but their use should be carefully considered due to potential side effects and drug interactions 3.
• Cephalexin is another effective oral antibiotic for treating streptococcal and staphylococcal skin infections, with cure rates of 90% or higher 4.
• The efficacy of cephalexin is comparable to other antibiotics such as erythromycin, clindamycin, and dicloxacillin, and its choice may depend on cost factors 4.
• Administration of oral antibiotics such as cephalexin twice a day can be as effective as four times a day, with minimal side effects 5.
• For community-acquired MRSA skin and soft tissue infections, doxycycline or trimethoprim-sulfamethoxazole with incision and drainage are recommended as initial therapy 6.
• New guidelines have been released for the treatment of skin and soft tissue infections, including recommendations on antibiotic prescription and effectiveness 7.