Disease | Drug Choice |
folliculitis, furuncles, carbuncles | warm compresses for less severe; incision/drainage;
Topical antibiotics: clindamycin, erythromycin, mupirocin, benzoyl peroxide BID-QID x 7days |
large/multiple furuncles and carbuncles: MRSA | systemic therapy x 7-10 days. Clindamycin, SMX/TMP, doxycycline |
large/multiple furuncles and carbuncles: MSSA/Strep | Penicillinase resistant penicillin, Clindamycin for PCN allergy |
Erysipelas ("St. Anthony's Fire") | -almost always GAS;
-Treat 7-10 days Oral Penicillin VK, IV aq Penicillin G for serious infections |
Lymphangitis | -Usually GAS;
-potentially serious so IV 48-72h, then PO x10 days;
-Aq Penicillin G, penicillin VK, clindamycin for PCN allergy;
-immobilize, elevate, warm soaks |
Cellulitis - suspected pathogens and non-pharm | -usually MSSA or GAS, but MRSA on rise (some gram neg anarobes in polymicrobial)
-elevate, cool saline dressings, moist heat |
Cellulitis - Simple | -7-10 days treatment;
-MSSA/GAS - oral dicloxacillin, cephalexin, clindamycin if beta lactam allergy |
Cellulitis - moderate/severe simple | -treat 10 - 14 days
-MSSA/GAS: IV nafcillin, cefazolin, clindamycin |
Cellulitis - MRSA | -oral: SMX/TMP, linezolid
-IV: vancomycin, linezolid, daptomycin, tigecycline |
Cellulitis - Polymicrobial mild | -Amoxicillin/clavulanate or fluoroquinolone
-PLUS clindamycin or metronidazole |
Cellulitis - Polymicrobial moderate/severe | -consider IV;
-ampicillin/sulbactam, or piperacillin/tazobactam, or carbapenem, or aminoglycocide;
-PLUS clindamycin or aminoglycocide;
-PLUS ampicillin;
-PLUS metronidazole |
Diabetic Foot Infections - oral treatment | -amoxicillin/clavulate, or fluoroquinolone;
-PLUS clindamycin or metronidazole;
-Treat 10 - 14 days, reevaluate in 48 - 72 hours |
Diabetic Foot Infections - IV treatment | -Ampicillin/sulbactam, or piperacillin/tazobactam, or carbapenem, or aminoglycoside;
-PLUS clindamycin or aminoglycoside;
-PLUS ampicillin;
-PLUS metronidazole;
--Treat 10 - 14 days, reevaluate in 48 - 72 hours |