Sandbox ID Skin and Soft Tissues: Difference between revisions
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* '''Impetigo (Staphylococcus and Streptococcus)''' | * '''Impetigo (Staphylococcus and Streptococcus)''' | ||
:* Preferred regimen (1): [[Dicloxacillin]] 250 mg PO qid | :* Preferred regimen (1): [[Dicloxacillin]] 250 mg PO qid | ||
:* Preferred regimen (2): [[Cephalexin]] 250 mg PO qid ( | :* Preferred regimen (2): [[Cephalexin]] 250 mg PO qid (pediatric dose: [[Cephalexin]] Orally 25–50 mg/kg/d in 3–4 divided doses) | ||
:* Preferred regimen (3): [[Erythromycin]]250 mg qid PO ( | :* Preferred regimen (3): [[Erythromycin]] 250 mg qid PO (pediatric dose: [[Erythromycin]] 40 mg/kg/d in 3–4 divided doses PO)(Some strains of Staphylococcus aureus and Streptococcus pyogenes may be resistant). | ||
:* Preferred regimen (4): [[Clindamycin]]300–400 mg qid PO ( | :* Preferred regimen (4): [[Clindamycin]] 300–400 mg qid PO (pediatric dose: [[Clindamycin]] 20 mg/kg/d in 3 divided doses PO) | ||
:* Preferred regimen (5): [[Amoxicillin- | :* Preferred regimen (5): [[Amoxicillin-Clavulanate]] 875/125 mg bid po (pediatric dose: 25 mg/kg/d of the amoxicillin component in 2 divided doses po) | ||
:* Preferred regimen (6): [[Retapamulin]] ointment applied to lesions bid ( | :* Preferred regimen (6): [[Retapamulin]] ointment applied to lesions bid (pediatric dose: Apply to lesions bid)(For patients with limited number of lesions) | ||
:* Preferred regimen (7): [[Mupirocin]] ointment applied to lesions bid ( | :* Preferred regimen (7): [[Mupirocin]] ointment applied to lesions bid (pediatric dose: Apply to lesions bid)(For patients with limited number of lesions) | ||
* '''MSSA SSTI''' | * '''MSSA SSTI''' | ||
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(table 5) | (table 5) | ||
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Revision as of 13:37, 27 May 2015
Staphylococcal and Streptococcal Skin and Soft Tissue Infections
(table 2)
- Impetigo (Staphylococcus and Streptococcus)
- Preferred regimen (1): Dicloxacillin 250 mg PO qid
- Preferred regimen (2): Cephalexin 250 mg PO qid (pediatric dose: Cephalexin Orally 25–50 mg/kg/d in 3–4 divided doses)
- Preferred regimen (3): Erythromycin 250 mg qid PO (pediatric dose: Erythromycin 40 mg/kg/d in 3–4 divided doses PO)(Some strains of Staphylococcus aureus and Streptococcus pyogenes may be resistant).
- Preferred regimen (4): Clindamycin 300–400 mg qid PO (pediatric dose: Clindamycin 20 mg/kg/d in 3 divided doses PO)
- Preferred regimen (5): Amoxicillin-Clavulanate 875/125 mg bid po (pediatric dose: 25 mg/kg/d of the amoxicillin component in 2 divided doses po)
- Preferred regimen (6): Retapamulin ointment applied to lesions bid (pediatric dose: Apply to lesions bid)(For patients with limited number of lesions)
- Preferred regimen (7): Mupirocin ointment applied to lesions bid (pediatric dose: Apply to lesions bid)(For patients with limited number of lesions)
- MSSA SSTI
- MRSA SSTI
- Non-purulent SSTI (cellulitis)
- Streptococcal skin infections
Incisional Surgical Site Infections
(table 3)
- Surgery of Intestinal or Genitourinary Tract
- Single-drug regimens
- Preferred regimen (1): Ticarcillin-clavulanate 3.1 g every 6 h IV
- Preferred regimen (2): Piperacillin-tazobactam 3.375 g every 6 h OR 4.5 g every 8 h IV
- Preferred regimen (3): Imipenem-cilastatin 500 mg every 6 h IV
- Preferred regimen (4): Meropenem 1 g every 8 h IV
- Preferred regimen (5): Ertapenem 1 g every 24 h IV
- Combination regimens
- Preferred regimen (1): Ceftriaxone 1 g every 24 h AND metronidazole 500 mg every 8 h
- Preferred regimen (2): IV Ciprofloxacin 400 mg IV every 12 h or 750 mg po every 12 h AND metronidazole 500 mg every 8 h
- Preferred regimen (3): IV Levofloxacin 750 mg IV every 24 h AND metronidazole 500 mg every 8 h
- Preferred regimen (4): IV Ampicillin-sulbactam 3 g every 6 h AND gentamicin OR tobramycin 5 mg/kg every 24 h IV
- Surgery of trunk or extremity away from axilla or perineum
- Preferred regimen (1): Oxacillin or nafcillin 2 g every 6 h IV
- Preferred regimen (2): Cefazolin 0.5–1 g every 8 h IV
- Preferred regimen (3): Cephalexin 500 mg every 6 h po
- Preferred regimen (4): SMX-TMP 160–800 mg po every 6 h
- Preferred regimen (5): Vancomycin 15 mg/kg every 12 h IV
- Surgery of axilla or perineum
- Preferred regimen: Metronidazole 500 mg every 8 h IV AND (Ciprofloxacin 400 mg IV every 12 h OR Ciprofloxacin 750 mg po every 12 h OR Levofloxacin 750 mg every 24 h IV/PO OR Ceftriaxone 1 g every 24 h)
Necrotizing Infections of the Skin, Fascia, and Muscle
(table 4)
- Mixed infections
- Streptococcus
- Staphylococcus aureus
- Clostridium species
- Aeromonas hydrophila
- Vibrio vulnificus
Infections Following Animal or Human Bites
(table 5)
Bite infections
- Animal bite
- Preferred regimen (1): Amoxicillin-clavulanate 875/125 mg PO bid (Some gram-negative rods are resistant; misses MRSA)
- Preferred regimen (2): Ampicillin-sulbactam 1.5–3.0 g IV every 6–8 h (Some gram-negative rods are resistant; misses MRSA)
- Preferred regimen (3): Piperacillin-tazobactam 3.37 g IV every 6–8 h (Misses MRSA)
- Preferred regimen (4): Doxycycline 100 mg PO bid OR 100 mg IV every 12 h (Excellent activity against Pasteurella multocida; some streptococci are resistant)
- Preferred regimen (5): Penicillin AND dicloxacillin 500 mg oral
- Preferred regimen (6): sulfamethoxazole-trimethoprim 160–800 mg PO bid OR IV 5–10 mg/kg/day of TMP component (Good activity against aerobes; poor activity against anaerobes)
- Preferred regimen (7): Metronidazole250–500 mg PO tid OR 500 mg IV every 8 h (Good activity against anaerobes; no activity against aerobes)
- Preferred regimen (8): Clindamycin300 mg PO tid OR 600 mg IV every 6–8 h (Good activity against staphylococci, streptococci, and anaerobes; misses P. multocida)
- Preferred regimen (9): Cefuroxime 500 mg PO bid OR 1 g IV every 12 h
- Preferred regimen (10): Cefoxitin 1g IV every 6–8 h
- Preferred regimen (11): Ceftriaxone 1g IV every 12 h
- Preferred regimen (12): Cefotaxime 1–2 g IV every 6–8 h
- Preferred regimen (13): Ciprofloxacin 500–750 mg PO bid OR 400 mg IV every 12 h
- Preferred regimen (14): Levofloxacin 750 mg PO daily OR 750 mg IV daily
- Preferred regimen (15): Moxifloxacin 400 mg PO daily OR 400 mg IV daily (Monotherapy; good for anaerobes also)
- Human bite
- Preferred regimen (15): Amoxicillin-clavulanate 875/125 mg PO bid (Some gram-negative rods are resistant; misses MRSA)
- Preferred regimen (15): Ampicillin-sulbactam 1.5–3.0 g IV every 6 h (Some gram-negative rods are resistant; misses MRSA)
- Preferred regimen (15): Doxycycline PO 100 mg bid (Good activity against Eikenella species, staphylococci, and anaerobes; some streptococci are resistant)
Cutaneous Anthrax
- Preferred regimen (1): (Penicillin Voral 500 mg 4 times daily (qid) for 7–10 days
- Preferred regimen (2): (Ciprofloxacin 500 mg by mouth (po) bid OR levofloxacin 500 mg intravenously (IV)/po every 24 hours × 60 days is recommended for bioterrorism cases because of presumed aerosol exposure
Cutaneous Anthrax
- Preferred regimen (1): (azithromycin
- Patients >45 kg: 500 mg on day 1 followed by 250 mg for 4 additional days
- Patients <45 kg: 10 mg/kg on day 1 and 5 mg/kg for 4 more days
- Preferred regimen (2): (erythromycin 500 mg by mouth (po) qid OR doxycycline 100 mg bid orally for 2 weeks to 2 months
-
- Preferred regimen: (Penicillin (500 mg qid) OR amoxicillin (500 mg 3 times daily [tid]) for 7–10 days
-
- Preferred regimen: (Ceftazidime, gentamicin, imipenem, doxycycline, or ciprofloxacin is recommended based on in vitro susceptibility
-
- Preferred regimen: (streptomycin (15 mg/kg intramuscularly [IM] every 12 hours) OR doxycycline (100 mg bid po) OR gentamicin could be substituted for streptomycin
-
- Preferred regimen (1): (streptomycin (15 mg/kg every 12 hours IM) OR gentamicin (1.5 mg/kg every 8 hours IV)
- Preferred regimen (2): (tetracycline (500 mg qid) OR doxycycline (100 mg bid po) is recommended for treatment of mild cases of tularemia