please note this is just a snippet of he skin infections and recommendations made. The link provides much more information and guidelines for the treatment and was reflective of the best medical practices as of 2014
. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America
Clinical Infectious Diseases, Volume 59, Issue 2, 15 July 2014, Pages e10–e52,
https://doi.org/10.1093/cid/ciu296
Published: 15 July 2014 Article history
A correction has been published:
Clinical Infectious Diseases, Volume 60, Issue 9, 1 May 2015, Page 1448,
https://doi.org/10.1093/cid/civ114]
https://academic.oup.com/cid/article/59/2/e10/2895845
Executive Summary
Summarized below are the recommendations made in the new guidelines for skin and soft tissue infections (SSTIs). Figure 1 was developed to simplify the management of localized purulent staphylococcal infections such as skin abscesses, furuncles, and carbuncles in the age of methicillin-resistant Staphylococcus aureus (MRSA). In addition, Figure 2 is provided to simplify the approach to patients with surgical site infections. The panel followed a process used in the development of other Infectious Diseases Society of America (IDSA) guidelines, which included a systematic weighting of the strength of recommendation and quality of evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system (Table 1) [1–4]. A detailed description of the methods, background, and evidence summaries that support each of the recommendations can be found in the full text of the guidelines.
Antimicrobial Therapy for Staphylococcal and Streptococcal Skin and Soft Tissue Infections
Disease Entity Antibiotic Dosage, Adults Dosage, Childrena Comment
Impetigob (Staphylococcus and Streptococcus) Dicloxacillin 250 mg qid po N/A N/A
Cephalexin 250 mg qid po 25–50 mg/kg/d in 3–4 divided doses po N/A
Erythromycin 250 mg qid poc 40 mg/kg/d in 3–4 divided doses po Some strains of Staphylococcus aureus and Streptococcus pyogenes may be resistant.
Clindamycin 300–400 mg qid po 20 mg/kg/d in 3 divided doses po N/A
Amoxicillin-clavulanate 875/125 mg bid po 25 mg/kg/d of the amoxicillin component in 2 divided doses po N/A
Retapamulin ointment Apply to lesions bid Apply to lesions bid For patients with limited number of lesions
Mupirocin ointment Apply to lesions bid Apply to lesions bid For patients with limited number of lesions
MSSA SSTI Nafcillin or oxacillin 1-2 g every 4 h IV 100–150 mg/kg/d in 4 divided doses Parental drug of choice; inactive against MRSA
Cefazolin 1 g every 8 h IV 50 mg/kg/d in 3 divided doses For penicillin-allergic patients except those with immediate hypersensitivity reactions. More convenient than nafcillin with less bone marrow suppression
Clindamycin 600 mg every 8 h IV or
300–450 mg qid po 25–40 mg/kg/d in 3 divided doses IV or
25–30 mg/kg/d in 3 divided doses po Bacteriostatic; potential of cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA
Dicloxacillin 500 mg qid po 25–50 mg/kg/d in 4 divided doses po Oral agent of choice for methicillin-susceptible strains in adults. Not used much in pediatrics
Cephalexin 500 mg qid po 25–50 mg/kg/d 4 divided doses po For penicillin-allergic patients except those with immediate hypersensitivity reactions. The availability of a suspension and requirement for less frequent dosing
Doxycycline, minocycline 100 mg bid po Not recommended for age <8 yd Bacteriostatic; limited recent clinical experience
Trimethoprim-sulfamethoxazole 1–2 double-strength tablets bid po 8–12 mg/kg (based on trimethoprim component) in either 4 divided doses IV or 2 divided doses po Bactericidal; efficacy poorly documented
MRSA SSTI Vancomycin 30 mg/kg/d in 2 divided doses IV 40 mg/kg/d in 4 divided doses IV For penicillin allergic patients; parenteral drug of choice for treatment of infections caused by MRSA
Linezolid 600 mg every 12 h IV or 600 mg bid po 10 mg/kg every 12 h IV or po for children <12 y Bacteriostatic; limited clinical experience; no cross-resistance with other antibiotic classes; expensive
Clindamycin 600 mg every 8 h IV or 300–450 mg qid po 25–40 mg/kg/d in 3 divided doses IV or 30–40 mg/kg/d in 3 divided doses po Bacteriostatic; potential of cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA. Important option for children
Daptomycin 4 mg/kg every 24 h IV N/A Bactericidal; possible myopathy
Ceftaroline 600 mg bid IV N/A Bactericidal
Doxycycline, minocycline 100 mg bid po Not recommended for age <8 yd Bacteriostatic; limited recent clinical experience
Trimethoprim-sulfamethoxazole 1–2 double-strength tablets bid po 8–12 mg/kg/d (based on trimethoprim component) in either 4 divided doses IV or 2 divided doses po Bactericidal; limited published efficacy data
Non-purulent SSTI (cellulitis) Adult dosage Pediatric dosage antimicrobial agents for patients with severe penicillin hypersensitivity N/A
Streptococcal skin infections Penicillin 2–4 million units every 4–6 h IV
Clindamycin 600–900 mg every 8 h IV
Nafcillin 1–2 g every 4–6 h IV
Cefazolin 1 g every 8 h IV
Penicillin VK 250–500 mg every 6 h po
Cephalexin 500 mg every 6 h po Penicillin 60–100 000 units/kg/dose every 6 h
10–13 mg/kg dose every 8 h IV
50 mg/kg/dose every 6 h
33 mg/kg/dose every 8 h IV Clindamycin, vancomycin, linezolid, daptomycin, or telavancin. Clindamycin resistance is <1% but may be increasing in Asia N/A