Skin and soft tissue antibiotics: Difference between revisions

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=Skin and Soft Tissue=
==[[Erysipelas]]==
{{Erysipelas antibiotics}}
==[[Cellulitis]]/Superficial [[Abscess]] with [[Cellulitis]]==
{{Cellulitis antibiotics}}
==[[Impetigo]]==
{{Impetigo Antibiotics}}
=[[Bioterrorism]]=
==[[Anthrax]]==
{{Anthrax antibiotics}}
==[[Botulism]]==
{{Botulism treatment}}
==[[Smallpox]]==
{{Smallpox Treatment}}
==[[Tularemia]]==
{{Tularemia antibiotics}}
==[[Yersinia]]==
{{Yersinia antibiotics}}
=Environmental Exposure=
==[[Mammalian bites]]==
{{Animal bite antibiotics}}
==[[Tetanus (Acute)]]==
{{Tetanus Antibiotics}}
==See Also==
{{Antibiotics by diagnosis navigation}}
{{Antibiotics by diagnosis navigation}}


Revision as of 23:27, 29 April 2015

Skin and Soft Tissue

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[1]) 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


Pediatric Inpatient

Saltwater related cellulitis

Freshwater related cellulitis

Impetigo

Coverage for MSSA, MRSA, Group A Strep

Topical therapy

Oral Therapy

Pediatric

Bioterrorism

Anthrax

Postexposure Prophylaxis

Patient should be vaccinated at day #0, #14, #28

Cutaneous Anthrax (not systemically ill)

Inhalation or Cutaneous with systemic illness

Pediatric Postexposure Prophylaxis

Pediatric Cutaneous Anthrax (not ill)

  • Same as pediatric postexposure dosing and duration

Pediatric Inhalational or Cutaneous (systemically ill)

  • Ciprofloxacin 15mg/kg IV q12hrs OR
  • Doxycycline 2.2mg/kg IV q12hrs PLUS
  • Imipenem/Cilastatin 1g IV q6h for at least 2wk
  • Imipenem/Cilastatin Neonates >32 wk gestation; 40-75 mg/kg/day IV divided q8-12h for at least 2wk; 1 month and older; 100 mg/kg/day IV divided q6h for at least 2wk
  • Rifampin 600 mg IV q12h for at least 2 wk as part of a multi-drug regimen; Switch to PO abx x60 days total if inhalational exposure
  • Rifampin Neonates >32 wk gestation; 10-20 mg/kg/day IV divided q12-24h for at least 2 wk as part of multi-drug regimen; 1+ mo; 20 mg/kg/day IV divided q12h for at least 2 wk as part of multi-drug regimen; Max: 300 mg/dose
  • Imipenem/Cilastatin 1g IV q6h for at least 2wk
  • Imipenem/Cilastatin Neonates >32 wk gestation; 40-75 mg/kg/day IV divided q8-12h for at least 2wk; 1 month and older; 100 mg/kg/day IV divided q6h for at least 2wk
  • Rifampin 600 mg IV q12h for at least 2 wk as part of a multi-drug regimen; Switch to PO abx x60 days total if inhalational exposure
  • Rifampin Neonates >32 wk gestation; 10-20 mg/kg/day IV divided q12-24h for at least 2 wk as part of multi-drug regimen; 1+ mo; 20 mg/kg/day IV divided q12h for at least 2 wk as part of multi-drug regimen; Max: 300 mg/dose

Botulism

Supportive Care

  • Early ventilatory support
    • Consider intubation when vital capacity <30% predicted or <12cc/kg
  • Wound Managment
    • Early wound debreedment with surgical consult.
    • Also exclude Necrotizing fasciitis and coverage with same broad antibiotic coverage


Foodborne Botulism

  • Equine Serum Botulism Antitoxin
    • only for patients > 1yo
  • Antitoxin obtained through CDC or local Department of Health.


Infant Botulism (<1yo)

  • Human-based Botulism IG 100mg/kg IV x 1 dose (BabyBIG)
    • infusion divided into 25mg/kg/hr IV x 15 min followed by 50mg/kg/hr if no allergic reactions
    • Stop infusion after total of 100mg/kg infused
  • BabyBIG obtained through CDC or local Department of Health


Inhalational Botulism

  • Equine Serum Botulism Antitoxin
    • only for patients > 1yo
  • Antitoxin obtained through CDC or local Department of Health


Wound Botulism

  • Individualize therapy with ID consultant
  • Broad antibiotic coverage same as for Necrotizing fasciitis while awaiting wound cultures

Smallpox

  • IMMEDIATE NOTIFICATION OF PUBLIC HEALTH AUTHORITIES
  • Vaccine administered up to 3 days post-exposure was effective in preventing infection as well as lessening the severity of the disease if infection occurred [2]

Post-Exposure Prophylaxis

  • Vaccinia Vaccine (administer within 72hrs of exposure)

Active Disease

  • Supportive care and wound care for open lesions
  • Vaccinia Vaccine within the first 72hrs can decrease total disease severity and within 7 days may decrease symptoms
    • Vaccination is not efficacious once the patient has developed rash[3]

Tularemia

Postexposure Prophylaxis

Active Disease

  • Streptomycin 1g (15mg/kg) IM q12hrs daily x 10 days (First line) OR
  • Gentamicin 5mg/kg/day IV/IM once daily x 10 days OR
  • Ciprofloxacin 400mg (15mg/kg) IV q12hrs x 10 days OR
  • Doxycycline 100mg (2.2mg/kg) IV q12hrs x 14 days OR
  • Chloramphenicol 15mg/kg IV q6hrs x 14 days
  • Streptomycin 1g IM q12h x10 days; Maximum dose: 2 g/day (adjust dose based on serum levels)
  • Streptomycin 15mg/kg IM q12h x10 days; Maximum dose: 2 g/day (adjust dose based on serum levels)

Pediatric

  • Gentamicin 2.5mg/kg IV/IM q8hrs x 10 days
  • Doxycycline 2.2mg/kg PO/IV q12hrs x 14 days (max 100mg/dose)
  • Ciprofloxacin 15mg/kg PO/IV q12hrs x 10 days (max 500mg PO / 400mg IV)

Yersinia

Postexposure Prophylaxis

Active Disease

  • Gentamicin 5mg/kg IV/IM once daily x 10 days OR
  • Ciprofloxacin 500mg (20mg/kg) PO q12hrs x 10 days OR
  • Doxycycline 200mg (2.2mg/kg) PO/IV daily
  • Streptomycin 1g IM q12h x10 days; Maximum dose: 2 g/day (adjust dose based on serum levels)
  • Streptomycin 15mg/kg IM q12h x10 days; Maximum dose: 2 g/day (adjust dose based on serum levels)

Pediatric

Environmental Exposure

Mammalian bites

====Cat and Dog Bites==== Coverage for Pasteurella, Strep, and Staph

  • Consider for high-risk wounds
    • wounds reaching the level of the muscle/tendon, wounds to the hand[4], violation of bone or joint capsule, immunocompromised hosts, wounds associated with significant local edema
  • Amoxicillin/Clavulanate 875mg PO BID x 5-7 days OR[5]
  • Doxycycline 100mg PO BID x 14 days if penicillin allergic [6]
  • Clindamycin 450mg (5mg/kg) PO q8hrs x 7 days PLUS


====Human Bites==== All human bites should be strongly considered for antibiotic therapy.[7]

Requires polymicrobial coverage for: S. aureus, Strep Viridans, Bacteroides, Coagulase-neg Staph, Eikenella, Fusobacterium, Cornebacterium, peptostreptococus

Pediatric:

====Mammalian Bites Severe Infections==== *Ampicillin/Sulbactam 3g IV (50mg/kg) q6hrs OR

Pediatric Cat and Dog Bites

Pediatric Severe Bite Infections

Tetanus (Acute)

Penicillin

  • Although once the drug of choice it is now no longer recommended since it may potentiate the effect of tetanus toxin by inhibiting the GABA receptors[8]

Pediatric

See Also

Antibiotics by diagnosis

For antibiotics by organism see Microbiology (Main)

References

  1. ↑ Linke M, Booken N. Risk factors associated with a reduced response in the treatment of erysipelas. J Dtsch Dermatol Ges. 2015 Mar;13(3):217-25.
  2. ↑ Kman NE, Nelson RN. Infectious agents of bioterrorism: a review for emergency physicians. Emerg Med Clin North Am. 2008 May;26(2):517-47
  3. ↑ Cdc.gov. 2020. Prevention and Treatment | Smallpox | CDC. [online] Available at: <https://www.cdc.gov/smallpox/prevention-treatment/index.html> [Accessed 11 September 2021].
  4. ↑ EBQ:Antibiotic prophylaxis for mammalian bites
  5. ↑ Griego RD, Rosen T, Orengo IF, Wolf JE. Dog, cat, and human bites: a review. J Am Acad Dermatol. 1995;33:1019–29.
  6. ↑ Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med. 1999;340:85–92.
  7. ↑ EBQ:Antibiotic prophylaxis for mammalian bites
  8. ↑ Ganesh Kumar AV. Benzathine penicillin, metronidazole and benzyl penicillin in the treatment of tetanus: a randomized, controlled trial .Ann Trop Med Parasitol. 2004 Jan;98(1):59-63 PMID 15000732
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