Skin and soft tissue antibiotics

Erysipelas

Coverage for S. pyogenes

• Penicillin G 300K U/d IM for <30 kg, 600K to 1 million U/d IM for >30 kg (first line therapy) OR
• Clindamycin 450mg (5mg/kg) PO q8hrs x 10 days (if PCN allergic) OR
• Cephalexin 500mg (6.25mg/kg) PO q6hrs x 10 days OR
• Ceftriaxone 1g (50mg/kg) IV once daily x 10 days OR
• Levofloxacin 500mg PO/IV daily x 10 days OR
• Amoxicillin/Clavulanate 500mg PO BID x 10 days (generally reserved for failure of first line therapy)

Bullous Erysipela or MRSA suspected: trimethoprim-sulfamethoxazole, clindamycin, doxycycline, or minocycline

Pediatric

• Penicillin G <30kg: 300,000 U/day IM; >30kg: 600,000-1 million U/day IM OR
• Cephalexin 25-50mg/kg/day PO divided q6-8h x 10 days (max 500mg/dose) OR
• Clindamycin 30mg/kg/day PO divided TID x 10 days (max 1.8g/day) OR
• Ceftriaxone 50mg/kg IV daily (max 2g) x 10 days

Cellulitis/Superficial Abscess with Cellulitis

Tailor antibiotics by regional antibiogram

Outpatient

• 5 day treatment duration
  • Cephalexin 500mg PO q6hrs OR
    • Add DS 1 tab PO BID if MRSA suspected
  • Clindamycin 450mg PO TID covers Strep and Staph

Pediatric Outpatient

• Cephalexin 25-50mg/kg/day PO divided q6-8h (max 500mg/dose) OR
  • Add 8-12mg/kg/day (TMP) PO divided BID if MRSA suspected
• Clindamycin 30-40mg/kg/day PO divided TID (max 1.8g/day)

Inpatient

• Vancomycin 20mg/kg IV q12hrs OR
• Clindamycin 600mg IV q8hrs OR
• Linezolid 600mg IV q12hrs OR
• Daptomycin 4mg/kg IV once daily

Pediatric Inpatient

• Vancomycin 15mg/kg IV q6hrs OR
• Clindamycin 10-13mg/kg IV q8hrs (max 900mg/dose) OR
• Linezolid <12yr: 10mg/kg IV q8hrs; >12yr: 600mg IV q12hrs

Saltwater related cellulitis

• Doxycycline 100mg PO/IV q12hrs daily + Cefepime 1g IV q12hrs x 10 days
• Ciprofloxacin 400mg IV q12hrs x 10 days

Freshwater related cellulitis

• Ciprofloxacin 500mg PO q12hrs x 10 days
• TMP/SMX 2 DS tablets PO q12hrs x 10 days
• Ceftriaxone 1g (50mg/kg) IV q24hrs

Impetigo

Coverage for MSSA, MRSA, Group A Strep

Topical therapy

• Mupirocin 2% ointment q8hrs x 5 days

Oral Therapy

• Cephalexin 500mg (6.25mg/kg) PO q6hrs x 10 days OR
• Amoxicillin/Clavulanate 875mg (12.5mg/kg) PO q12hrs x 10 days OR
• Clindamycin 450mg PO q8hrs (or 10mg/kg PO q6hrs) x 10 days OR
• Dicloxacillin 500mg (3mg/kg) PO q6hrs x 10 days

Pediatric

• Mupirocin 2% ointment applied TID x 5 days
• Cephalexin 25-50mg/kg/day PO divided q6-8h x 7-10 days (max 500mg/dose) OR
• Amoxicillin/Clavulanate 25mg/kg/day PO divided BID x 7-10 days OR
• Clindamycin 30mg/kg/day PO divided TID (max 1.8g/day) OR
• Dicloxacillin 12.5-25mg/kg/day PO divided q6h x 7-10 days

Mastitis

• No need to routinely interrupt breastfeeding with puerperal mastitis.
• For mild symptoms <24 hours, supportive care may be sufficient
  • Effective milk removal (frequent breast feeding - use pumping to augment milk removal)
  • Analgesia (NSAIDs)

Treatment directed at S. aureus and Strep and E. coli

• Uncomplicated mastitis → 10 days of antibiotics (regardless of MRSA suspicion)
• Dicloxacillin 500mg PO q6hrs OR
• Cephalexin 500mg PO q6hrs OR
  • Add TMP/SMX 2DS tabs PO q12hrs if suspect MRSA
• Clindamycin 450mg PO q8hrs OR
• Amoxicillin/Clavulanate 875mg PO q12hrs OR
• Azithromycin 500mg PO x1 day 1, then 250mg PO daily days 2-5

See Also

Antibiotics by diagnosis

• Bone and joint antibiotics
• Cardiovascular antibiotics
• ENT antibiotics
• Eye antibiotics
• GI antibiotics
• GU antibiotics
• Neuro antibiotics
• OB/GYN antibiotics
• Pulmonary antibiotics
• Skin and soft tissue antibiotics
• Bioterrorism antibiotics
• Environmental exposure antibiotics
• Immunocompromised antibiotics
• Post exposure prophylaxis antibiotics
• Pediatric antibiotics
• Sepsis antibiotics
• Arthropod and parasitic antibiotics

For antibiotics by organism see Microbiology (Main)