Treatment of Common Infections of the Skin
| Diagnosis/Condition | Primary Treatment | Alternative Treatment | See Also Chap(s). |
|---|---|---|---|
| Animal bite (prophylaxis or early infection)a | Amoxicillin/clavulanate, 875/125 mg PO bid | Doxycycline, 100 mg PO bid | 27 |
| Animal bitea (established infection) | Ampicillin/sulbactam, 1.5-3 g IV q6h | Clindamycin, 600-900 mg IV q8h, plus Ciprofloxacin, 400 mg IV q12h, orcefoxitin, 2 g IV q6h | 27 |
| Bacillary angiomatosis | Erythromycin, 500 mg PO qid | Doxycycline, 100 mg PO bid | 91 |
| Herpes simplex (primary genital) | Acyclovir, 400 mg PO tid for 10 days | Famciclovir, 250 mg PO tid for 5-10 days, | 99 |
| or | |||
| Valacyclovir, 1000 mg PO bid for 10 days | |||
| Herpes zoster (immunocompetent host >50 years of age) | Acyclovir, 800 mg PO 5 times daily for 7-10 days | Famciclovir, 500 mg PO tid for 7-10 days, or Valacyclovir, 1000 mg PO tid for 7 days | 99 |
| Cellulitis (staphylococcal or streptococcalb,c) | Nafcillin or oxacillin, 2 g IV q4-6h | Cefazolin, 1-2 g q8h, or Ampicillin/sulbactam, 1.5-3 g IV q6h, or Erythromycin, 0.5-1 g IV q6h, or Clindamycin, 600-900 mg IV q8h | 86, 87 |
| MRSA skin infectiond | Vancomycin, 1 g IV q12h | Linezolid, 600 mg IV q12h | 86 |
| Necrotizing fasciitis (group A streptococcalb) | Clindamycin, 600-900 mg IV q6-8h, plus Penicillin G, 4 million units IV q4h | Clindamycin, 600-900 mg IV q6-8h, plus Cephalosporin (first- or second-generation) | 87 |
| Necrotizing fasciitis (mixed aerobes and anaerobes) | Ampicillin, 2 g IV q4h, plus Clindamycin, 600-900 mg IV q6-8h, plus Ciprofloxacin, 400 mg IV q6-8h | Vancomycin, 1 g IV q6h, plus Metronidazole, 500 mg IV q6h, plus Ciprofloxacin, 400 mg IV q6-8h | 92 |
| Gas gangrene | Clindamycin, 600-900 mg IV q6-8h, | Clindamycin, 600-900 mg IV q6-8h, | 92 |
| plus | plus | ||
| Penicillin G, 4 million units IV q4-6h | Cefoxitin, 2 g IV q6h |
aPasteurella multocida, a species commonly associated with both dog and cat bites, is resistant to cephalexin, dicloxacillin, clindamycin, and erythromycin. Eikenella corrodens, a bacterium commonly associated with human bites, is resistant to clindamycin, penicillinase-resistant penicillins, and metronidazole but is sensitive to trimethoprim-sulfamethoxazole and fluoroquinolones.
bThe frequency of erythromycin resistance in group A Streptococcus is currently ~5% in the United States but has reached 70-100% in some other countries. Most, but not all, erythromycin-resistant group A streptococci are susceptible to clindamycin. Approximately 90% of Staphylococcus aureus strains are sensitive to clindamycin, but resistance—both intrinsic and inducible—is increasing.
cSevere hospital-acquired S. aureus infections or community-acquired S. aureus infections that are not responding to the β-lactam antibiotics recommended in this table may be caused by methicillin-resistant strains, requiring a switch to vancomycin, daptomycin, or linezolid.
dSome strains of methicillin-resistant S. aureus (MRSA) remain sensitive to tetracycline and trimethoprim-sulfamethoxazole. Daptomycin (4 mg/kg IV q24h) or tigecycline (100-mg loading dose followed by 50 mg IV q12h) is an alternative treatment for MRSA.