Antimicrobial Management: Skin & Soft Tissue Infections

Follow these guidelines for assistance in the management of antibiotic therapy for SSTIs.

Skin and soft tissue infections (SSTIs) represent one of the most common reasons for antibiotic use. The clinical spectrum of SSTIs ranges from mild, self-limiting inflammation to life-threatening infectious processes. Varying infectious etiologies include viruses, bacteria, fungi, protozoa, and helminthes. Staphylococci, including methicillin-resistant Staphylococcus aureus (MRSA), remain the predominant bacterial cause of SSTI, followed by Group A streptococci. Part of antibiotic stewardship is recognizing when antibiotics are unnecessary and can be avoided. Antibiotic therapy is typically indicated in patients experiencing two or more of the following classical findings: purulent discharge, pain or tenderness, erythema, induration, or increased warmth. Due to lack of activity against MRSA, β-lactam antibiotics, which include penicillins and cephalosporins, no longer represent the most reliable option as empiric therapy for SSTI. Furthermore, fluoroquinolones, including ciprofloxacin, levofloxacin, and moxifloxacin, aren’t ideal antibiotics to use against MRSA, as resistance may develop during therapy. Tetracyclines, clindamycin, and trimethoprim/sulfamethoxazole (Bactrim) are some oral options for infections due to MRSA. Table 1 below will assist wound care providers in the management of localized purulent staphylococcal infections such as abscesses, furuncles, and carbuncles in the age of MRSA. Additionally, Table 2 provides defined antibiotic therapy. It is important to note the spectrum of activity of each antibiotic listed (Table 3).

Thomas M. Bozzuto is medical director at Phoebe Wound Care and Hyperbaric Center, Albany, GA. Daniel B. Chastain is an infectious diseases pharmacy specialist in the inpatient pharmacy at Phoebe Putney Memorial Hospital, Albany, GA

Resource

Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):147-59. doi: 10.1093/cid/ciu296. Epub 6/18/14.