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) | 29 Bites, Venoms, Stings, and Marine Poisonings |
| Animal bitea (established infection) | Ampicillin-sulbactam (1.5-3 g IV q6h) | Clindamycin (600-900 mg IV q8h) plus Ciprofloxacin (400 mg IV q12h) or cefoxitin (2 g IV q6h) | 29 Bites, Venoms, Stings, and Marine Poisonings |
| Bacillary angiomatosis | Erythromycin (500 mg PO qid) | Doxycycline (100 mg PO bid) | 94 Infections Caused by Miscellaneous Gram-Negative Bacilli |
| Herpes simplex (primary genital) | Acyclovir (400 mg PO tid for 10 days) | Famciclovir (250 mg PO tid for 5-10 days) or valacyclovir (1000 mg PO bid for 10 days) | 102 Infections with Herpes Simplex Virus, Varicella-Zoster Virus, Cytomegalovirus, Epstein-Barr Virus, and Human Herpesvirus Types 6, 7, and 8 |
| 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) | 102 Infections with Herpes Simplex Virus, Varicella-Zoster Virus, Cytomegalovirus, Epstein-Barr Virus, and Human Herpesvirus Types 6, 7, and 8 |
| 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) | 89 Staphylococcal Infections, 90 Streptococcal/Enterococcal Infections, Diphtheria, and Infections Caused by Other Corynebacteria and Related Species |
| MRSA skin infectiond | Vancomycin (1 g IV q12h) | Linezolid (600 mg IV q12h) | 89 Staphylococcal Infections |
| 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 a cephalosporin (first- or second-generation) | 90 Streptococcal/Enterococcal Infections, Diphtheria, and Infections Caused by Other Corynebacteria and Related Species |
| 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) | 95 Anaerobic Infections |
| Gas gangrene | Clindamycin (600-900 mg IV q6-8h) plus penicillin G (4 million units IV q4-6h) | Clindamycin (600-900 mg IV q6-8h) plus cefoxitin (2 g IV q6h) | 95 Anaerobic Infections |
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.
b The 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.
c Severe 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.
d Some 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.