Skin and Soft Tissue Infections

(SSTIs)by Jeuel Pana

Presented
Clinical Diagnosis:
Cellulitis:
Erysipelas
Abscesses (felon vs. paronychia)
Management

■ Determined by the severity and location

■ Classification (simple vs. complicated)
■ Lab testing
Management (continued)

■ Purulent versus non-purulent

 Management (continued)
■ Purulent
– Incise and drain if abscess
– Antibiotics?
– Cover for MRSA

– Simple SSTIs
– Most out-patient adequate
– Empiric oral abx:
clindamycin, TMP-SMX,
doxy/mino-cycline
Dosing
TMP-SMX: 1 to 2 double strength tablets orally twice
daily.
Clindamycin: 300 to 450 mg orally four times daily.
Doxycycline: 100 mg orally twice daily.
Vancomycin 15 to 20 mg/kg/dose IV every 8 to 12 hou

– Complicated SSTIs
– Parenteral abx: Vanco
Management (continued)
■ Technique for I&D
– Note contraindications

– Steps:
■ Adequate anesthesia
■ Incision
■ Probe
■ Irrigation
■ Closure
Management (continued)
■ Non-Purulent
– Treat underlying condition
– Empiric abx
– MRSA coverage?

– Simple SSTIs Dosing

– Most out-patient adequate Cephalexin 500 mg orally four times daily.

– Empiric oral abx: Keflex, Cefazolin 1 to 2 g IV every 8 hours.

Ceftriaxone 1 to 2 g IV every 24 hours.

– Complicated SSTIs
– Parenteral abx: Cefazolin,
Ceftriaxone
Management (continued)
■ Duration of treatment
– Depends on clinical response
– MRSA responsive to PO rx, 5-14 days
– Lack of response?

– Parenteral therapy, 5-14 days

– Transition to PO
Recently Developed Antimicrobial Therapy

■ Addresses inadequate MRSA treatment and recurrence

– Ortavancin (single dose $2600)
– Dalbavancin (two doses $4500)
– Tedizolid
References

■ Online References
– http://www.uptodate.com
– http://www.medscape.com
– http://www.aafp.org
– Images from http://images.google.com