Skin and soft tissue infections are diagnosed principally by a careful history (e.g., temporal progression, travel, animal exposure, bites, trauma, underlying medical conditions) and physical examination (appearance of lesions and distribution). Treatment of common skin infections is summarized in Table 87-1; parenteral treatment is usually given until systemic signs and symptoms have improved. Types of skin lesions include the following:
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 |
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 |
Bacillary angiomatosis | Erythromycin (500 mg PO qid) | Doxycycline (100 mg PO bid) | 94 |
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 |
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 |
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, 90 |
MRSA skin infectiond | Vancomycin (1 g IV q12h) | Linezolid (600 mg IV q12h) | 89 |
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 |
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 |
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 |
There's more to see -- the rest of this topic is available only to subscribers.