Sandbox ID Skin and Soft Tissues: Difference between revisions

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===Acne vulgaris===
===Acne vulgaris===
*Acne vulgaris<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
* Acne vulgaris<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>


:* Earliest form, No inflammation  
:* '''Earliest form, no inflammation'''
::* Preferred regimen (1) : Topical [[tretinoin]] (cream 0.025 or 0.05%) or (gel 0.01 or 0.025%) once 24 hrs
::* Preferred regimen: [[Tretinoin]] (cream 0.025 or 0.05%) Topical qd {{or}} (gel 0.01 or 0.025%) qd
::* Alternative regimen (1): Topical [[adapalene]] 0.1 % gel {{or}} [[azelaic acid]] 20% cream {{or}} [[tazarotene]] 0.1% cream once 24hrs
::* Alternative regimen (1): [[Adapalene]] 0.1 % gel Topical qd
::* Alternative regimen (2): [[Azelaic acid]] 20% cream Topical qd
::* Alternative regimen (3): [[Tazarotene]] 0.1% cream Topical qd
::* Note: Expect 40–70% decrease in comedones in 12 weeks


:* Mild inflammation
:* '''Mild inflammation'''
::* Preferred regimen (1) : Topical [[erythro]] 3% {{and}} [[benzoyl peroxide]] 5% bid
::* Preferred regimen: [[Erythromycin]] 3% Topical {{and}} [[Benzoyl peroxide]] 5% Topical bid
::* Alternative regimen (1): Topical [[clindamycin]] 1% gel bid {{and}} [[benzoyl peroxide]] 5% bid
::* Alternative regimen: [[Clindamycin]] 1% gel Topical bid {{and}} [[Benzoyl peroxide]] 5% Topical bid


:* Inflammation
:* '''Moderate to severe inflammation'''
::* Preferred regimen (1) : Topical [[erythro]] 3% {{and}} [[benzoyl peroxide]] 5% bid {{and}}/ {{or}} oral antibiotic
::* Preferred regimen (1): [[Erythromycin]] 3% Topical {{and}} [[Benzoyl peroxide]] 5% bid {{withorwithout}} oral antibiotic
::* Alternative regimen (1): Oral [[doxycycline]] 50mg bid {{or}} [[minocycline]] 50 mg bid
::* Preferred regimen (2): [[Isotretinoin]] 0.1–1 mg/kg IV qd for 4–5 months for severe widespread nodular cystic lesions that fail oral antibiotic treatment
::* Alternative regimen (2): Expensive extended release: once daily [[minocycline]] 1mg/kg/d
 
::* Alternative regimen (1): [[Doxycycline]] 100 mg PO bid
 
::* Alternative regimen (2):[[Minocycline]] 50 mg PO bid {{or}} [[Minocycline]] 1 mg/kg expensive extended release qd
::* Note: Other alternatives include tetracycline, erythromycin, TMP-SMX, clindamycin


===Acne rosacea===
===Acne rosacea===
*Acne rosacea <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
* Acne rosacea <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:*Facial erythema
:* 1. '''Facial erythema'''
::* Preferred regimen : [[Brimonidine]] gel applied to the affected area bid
::* Preferred regimen: [[Brimonidine]] gel Topical bid, applied to the affected area
:*Papulopustular rosacea:
:* 2. '''Papulopustular rosacea'''
::* Preferred regimen : [[Azelaic acid]] gel bid topical {{or}} [[Metronidazole]] topical cream once daily.
::* Preferred regimen (1): [[Azelaic acid]] gel Topical bid
 
::* Preferred regimen (2): [[Metronidazole]] cream Topical qd


===Anthrax, cutaneous===
===Anthrax, cutaneous===
* '''Cutaneous anthrax'''
* 1. '''Cutaneous anthrax'''<ref name="pmid24447897">{{cite journal| author=Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT et al.| title=Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24447897 | doi=10.3201/eid2002.130687 | pmc=PMC3901462 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24447897  }} </ref>
:* Preferred regimen (1): [[Penicillin V]] 500 mg PO qid for 7–10 days  
:* Preferred regimen (1): [[Penicillin V]] 500 mg PO qid for 7–10 days  
:* Preferred regimen (2): [[Ciprofloxacin]] 500 mg PO bid {{or}} [[Levofloxacin]] 500 mg IV/PO every 24 hours for 60 days is recommended for bioterrorism cases because of presumed aerosol exposure
:* Preferred regimen (2): [[Ciprofloxacin]] 500 mg PO bid  
 
:* Preferred regimen (3): [[Levofloxacin]] 500 mg IV/PO qd for 60 days is recommended for bioterrorism cases because of presumed aerosol exposure


===Bacillary angiomatosis===
===Bacillary angiomatosis===
* '''Bacillary angiomatosis'''
* '''Bacillary angiomatosis'''<ref name="pmid9494835">{{cite journal| author=Spach DH, Koehler JE| title=Bartonella-associated infections. | journal=Infect Dis Clin North Am | year= 1998 | volume= 12 | issue= 1 | pages= 137-55 | pmid=9494835 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9494835  }} </ref>
:* Preferred regimen: [[Erythromycin]] 500 mg PO qid for 2 weeks to 2 months {{or}} [[Doxycycline]] 100 mg PO bid for 2 weeks to 2 months
::* Preferred regimen (1): [[Erythromycin]] 500 mg PO qid for 2 weeks to 2 months  
 
::* Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 2 weeks to 2 months
 
:* 1. '''Management of Treatment Failure'''<ref name="pmid19730409">{{cite journal| author=Mofenson LM, Brady MT, Danner SP, Dominguez KL, Hazra R, Handelsman E et al.| title=Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-exposed and HIV-infected children: recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. | journal=MMWR Recomm Rep | year= 2009 | volume= 58 | issue= RR-11 | pages= 1-166 | pmid=19730409 | doi= | pmc=PMC2821196 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19730409  }} </ref>
::* In immunocompromised patients with relapse, retreatment should be continued for 4--6 months; repeated relapses should be treated indefinitely 
::* Among patients whose Bartonella infections fail to respond to initial treatment, one or more of the second-line regimens should be considered
:* 2. '''Prevention of Recurrence'''<ref name="pmid19730409">{{cite journal| author=Mofenson LM, Brady MT, Danner SP, Dominguez KL, Hazra R, Handelsman E et al.| title=Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-exposed and HIV-infected children: recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. | journal=MMWR Recomm Rep | year= 2009 | volume= 58 | issue= RR-11 | pages= 1-166 | pmid=19730409 | doi= | pmc=PMC2821196 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19730409  }} </ref>
 
::* Relapses in bone and skin have been reported and are more common when antibiotics are administered for a shorter time (<3 months)
::* For an immunocompromised HIV-infected adult experiencing relapse, long-term suppression of infection with doxycycline or a macrolide is recommended as long as the CD4 cell count is <200 cells/mm3


===Bite wounds===
===Bite wounds===
* '''Animal bite'''
* Bite wounds<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:* Preferred regimen (1): [[Amoxicillin-clavulanate]] 875/125 mg PO bid (Some gram-negative rods are resistant; misses MRSA)
:* '''Animal bite'''
:* Preferred regimen (2): [[Ampicillin-sulbactam]]  1.5–3.0 g IV every 6–8 h (Some gram-negative rods are resistant; misses MRSA)
::* Preferred regimen (1): [[Amoxicillin-clavulanate]] 875/125 mg PO bid (some gram-negative rods are resistant; misses MRSA)
:* Preferred regimen (3): [[Piperacillin-tazobactam]] 3.37 g IV every 6–8 h (Misses MRSA)
::* Preferred regimen (2): [[Ampicillin-sulbactam]]  1.5–3.0 g IV q6–8 h (some gram-negative rods are resistant; misses MRSA)
:* Preferred regimen (4): [[Doxycycline]] 100 mg PO bid {{or}} 100 mg IV every 12 h (Excellent activity against [[Pasteurella multocida]]; some streptococci are resistant)
::* Preferred regimen (3): [[Piperacillin-tazobactam]] 3.37 g IV q6–8 h (misses MRSA)
:* Preferred regimen (5): [[Penicillin]] {{and}} [[Dicloxacillin]] 500 mg oral
::* Preferred regimen (4): [[Doxycycline]] 100 mg PO bid {{or}} 100 mg IV q12h (excellent activity against Pasteurella multocida; some streptococci are resistant)
:* Preferred regimen (6): [[sulfamethoxazole]]-[[Trimethoprim]] 160–800 mg PO bid {{or}} IV 5–10 mg/kg/day of TMP component (Good activity against [[aerobes]]; poor activity against anaerobes)
::* Preferred regimen (5): [[Penicillin]] {{and}} [[Dicloxacillin]] 500 mg PO
:* Preferred regimen (7): [[Metronidazole]] 250–500 mg PO tid {{or}} 500 mg IV every 8 h (Good activity against anaerobes; no activity against aerobes)
::* Preferred regimen (6): [[Trimethoprim-Sulfamethoxazole]] 160–800 mg PO bid {{or}} 5–10 mg/kg IV q24h of TMP component (good activity against [[aerobes]]; poor activity against anaerobes)
:* Preferred regimen (8): [[Clindamycin]] 300 mg PO tid {{or}} 600 mg IV every 6–8 h (Good activity against [[staphylococci]], [[streptococci]], and [[anaerobes]]; misses [[P. multocida]])
::* Preferred regimen (7): [[Metronidazole]] 250–500 mg PO tid {{or}} 500 mg IV q8h (Good activity against anaerobes; no activity against aerobes)
:* Preferred regimen (9): [[Cefuroxime]] 500 mg PO bid {{or}} 1 g IV every 12 h
::* Preferred regimen (8): [[Clindamycin]] 300 mg PO tid {{or}} 600 mg IV q6–8h (Good activity against staphylococci, streptococci, and anaerobes; misses [[Pasteurella|P. multocida]])
:* Preferred regimen (10): [[Cefoxitin]] 1g IV every 6–8 h
::* Preferred regimen (9): [[Cefuroxime]] 500 mg PO bid {{or}} 1 g IV q12h
:* Preferred regimen (11): [[Ceftriaxone]] 1g IV every 12 h
::* Preferred regimen (10): [[Cefoxitin]] 1 g IV q6–8h
:* Preferred regimen (12): [[Cefotaxime]] 1–2 g IV every 6–8 h
::* Preferred regimen (11): [[Ceftriaxone]] 1 g IV q12h
:* Preferred regimen (13): [[Ciprofloxacin]] 500–750 mg PO bid {{or}} 400 mg IV every 12 h
::* Preferred regimen (12): [[Cefotaxime]] 1–2 g IV q6–8h
:* Preferred regimen (14): [[Levofloxacin]] 750 mg PO daily {{or}} 750 mg IV daily
::* Preferred regimen (13): [[Ciprofloxacin]] 500–750 mg PO bid {{or}} 400 mg IV q12h
:* Preferred regimen (15): [[Moxifloxacin]] 400 mg PO daily {{or}} 400 mg IV daily (Monotherapy; good for anaerobes also)
::* Preferred regimen (14): [[Levofloxacin]] 750 mg PO qd{{or}} 750 mg IV q24h
::* Preferred regimen (15): [[Moxifloxacin]] 400 mg PO qd {{or}} 400 mg IV q24h (monotherapy good for anaerobes also)


* '''Human bite'''
:* '''Human bite'''
:* Preferred regimen (1): [[Amoxicillin-clavulanate]] 875/125 mg PO bid (Some gram-negative rods are resistant; misses MRSA)
::* Preferred regimen (1): [[Amoxicillin-clavulanate]] 875/125 mg PO bid (some gram-negative rods are resistant; misses MRSA)
:* Preferred regimen (2): [[Ampicillin-sulbactam]] 1.5–3.0 g IV every 6 h (Some gram-negative rods are resistant; misses MRSA)
::* Preferred regimen (2): [[Ampicillin-sulbactam]] 1.5–3.0 g IV q6h (some gram-negative rods are resistant; misses MRSA)
:* Preferred regimen (3): [[Doxycycline]] PO 100 mg bid (Good activity against [[Eikenella]] species, [[staphylococci]], and [[anaerobes]]; some streptococci are resistant)
::* Preferred regimen (3): [[Doxycycline]] 100 mg PO bid (good activity against eikenella species, staphylococci, and anaerobes; some streptococci are resistant)


===Lyme disease, cutaneous===
===Lyme disease, cutaneous===
* Preferred oral regimens '''adults'''
* Lyme disease<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
: * Preferred regimen (1): [[Amoxicillin]] 500 mg 3 times per day
 
: * Preferred regimen (2): [[Doxycycline]] 100 mg twice per day 
:* 1. '''Adults'''
: * Preferred regimen (3): [[Cefuroxime axetil]] 500 mg twice per day 30 mg/kg per day in 2 divided doses (maximum, 500 mg per dose)  
::* Preferred regimen (1): [[Amoxicillin]] 500 mg PO tid
* Alternative oral regimens '''adults'''
::* Preferred regimen (2): [[Doxycycline]] 100 mg PO bid
: * Preferred regimen (1): [[Doxycycline]], 200 mg in a single dose
::* Preferred regimen (3): [[Cefuroxime axetil]] 500 mg PO bid {{or}} 30 mg/kg/day PO bid (maximum, 500 mg/dose)
* Preferred parenteral regimen '''adults'''
::* Preferred regimen (4): [[Ceftriaxone]] 2 g IV q24h
: * Preferred regimen (1): [[Ceftriaxone]] 2 g intravenously once per day
::* Alternative regimen (1): [[Doxycycline]] 200 mg PO single dose
* Alternative parenteral regimens '''adults'''
::* Alternative regimen (2): [[Cefotaxime]] 2 g IV q8h
: * Preferred regimen (1): [[Cefotaxime]] 2 g intravenously every 8 hd d
::* Alternative regimen (3): [[Penicillin G]] 18–24 MU/day IV q4h
: * Preferred regimen (2): [[Penicillin G]] 18–24 million U per day intravenously, divided every 4 h
:* 2. '''Pediatrics'''
* Preferred oral regimens '''pediatrics'''
::* Preferred regimen (1): [[Amoxicillin]] 50 mg/kg/day PO tid (maximum, 500 mg/dose)
: * Preferred regimen (1): [[Amoxicillin]] 50 mg/kg per day in 3 divided doses (maximum, 500 mg per dose)
::* Preferred regimen (2):  For children aged 8 years, 4 mg/kg/day PO bid (maximum, 100 mg/dose)
: * Preferred regimen (2): [[Doxycycline]] Not recommended for children aged !8 years. For children aged 8 years, 4 mg/kg per day in 2 divided doses (maximum, 100 mg per dose)
::* Note: Doxycycline Not recommended for children aged 8 years.
: * Preferred regimen (3): [[Cefuroxime axetil]] 30 mg/kg per day in 2 divided doses (maximum, 500 mg per dose)
::* Preferred regimen (3): [[Cefuroxime axetil]] 30 mg/kg/day PO bid (maximum, 500 mg/dose)
* Alternative oral regimens '''pediatrics'''
::* Preferred regimen (4): [[Ceftriaxone]] 50–75 mg/kg/day IV q24h (maximum, 2 g)
: * Preferred regimen (1): [[Doxycycline]], (4 mg/kg in children <8 years of age)
::* Alternative regimen (1): [[Doxycycline]] PO (4 mg/kg in children < 8 years of age)  
* Preferred parenteral regimen '''pediatrics'''
::* Alternative regimen (2): [[Cefotaxime]] 150–200 mg/kg/day IV q6-8h (maximum, 6 g/day)
: * Preferred regimen (1): [[Ceftriaxone]] 50–75 mg/kg intravenously per day in a single dose (maximum, 2 g)  
::* Alternative regimen (3): [[Penicillin G]] 0.2–0.4 MU/kg/day q4h (not to exceed 18–24 MU/day)
* Alternative parenteral regimens '''pediatrics'''
: * Preferred regimen (1): [[Cefotaxime]] 150–200 mg/kg per day intravenously in 3–4 divided doses (maximum, 6 g per day)
: * Preferred regimen (2): [[Penicillin G]] 200,000–400,000 U/kg per day divided every 4 h (not to exceed 18–24 million U per day)


===Bubonic plague===
===Bubonic plague===
* '''Bubonic Plague'''
* '''Bubonic Plague'''<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:* Preferred regimen: [[Streptomycin]] 15 mg/kg IM every 12 hours {{or}} [[Doxycycline]] 100 mg bid PO {{or}} [[Gentamicin]] could be substituted for [[streptomycin]]
:* Preferred regimen (1): [[Streptomycin]] 15 mg/kg IM q12h
 
:* Preferred regimen (2): [[Doxycycline]] 100 mg PO bid
:* Preferred regimen (3): [[Gentamicin]] could be substituted for [[streptomycin]]


===Carbuncle===
===Carbuncle===
* Carbuncle<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
* Carbuncle<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:*Mild   : Incision and Drainage
:* '''Mild''' 
:*Moderate  
::* Preferred treatment: Incision and Drainage
::*Empiric treatment :[[TMP-SMX]] {{or}} [[Doxycycline]]
:* '''Moderate'''
::*Culture directed treatment
::* Empiric treatment: [[TMP-SMX]] {{or}} [[Doxycycline]]
:::*MSSA : [[TMP-SMX]]
::* Culture directed treatment
:::*MRSA : [[dicloxacillin]] {{or}} [[cephalexin]]
:::* MSSA: [[TMP-SMX]]
:::* MRSA: [[Dicloxacillin]] {{or}} [[Cephalexin]]
:* '''Severe'''
::* Empiric treatment: [[Vancomycin]] {{or}} [[Daptomycin]] {{or}} [[Linezolid]] {{or}} [[Televancin]] {{or}} [[Ceftaroline]]
::* Culture directed treatment
:::* MSSA: [[Nafcillin]] {{or}} [[Cefazolin]] {{or}} [[Clindamycin]]
:::* MRSA: [[Vancomycin]] {{or}} [[Daptomycin]] {{or}} [[Linezolid]] {{or}} [[Televancin]] {{or}} [[Ceftaroline]]


:*Severe
===Cat scratch disease===
::*Empiric treatment :[[Vancomycin]] {{or}} [[daptomycin]] {{or}} [[linezolid]] {{or}} [[televancin]] {{or}} [[ceftaroline]]
* Cat scratch disease<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
::*Culture directed treatment
:::*MSSA : [[Nafcillin]] {{or}} [[cefazolin]] {{or}} [[clindamycin]]
:::*MRSA :[[Vancomycin]] {{or}} [[daptomycin]] {{or}} [[linezolid]] {{or}} [[televancin]] {{or}} [[ceftaroline]]


===Cat scratch disease===
:* '''Cat scratch disease in patients > 45 kg'''
* '''Cat scratch disease in patients > 45 kg'''
::* Preferred regimen: [[Azithromycin]] 500 mg PO on day 1 {{and}} 250 mg PO for additional 4 days
:* Preferred regimen: [[Azithromycin]] 500 mg on day 1 followed by 250 mg for 4 additional days


* '''Cat scratch disease in patients < 45 kg'''
:* '''Cat scratch disease in patients < 45 kg'''
:* Preferred regimen: [[Azithromycin]] 10 mg/kg on day 1 and 5 mg/kg for 4 more days
::* Preferred regimen: [[Azithromycin]] 10 mg/kg PO on day 1 {{and}} 5 mg/kg PO for 4 more days


===Cellulitis===
===Cellulitis===
*Non purulent :
* Cellulitis<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:*Mild : Typical cellulitis/erysipelas with no focus of purulence  
:* '''Non purulent Cellulitis'''
::*Preferred treatment : [[Pencillin]] VK {{or}} [[cephalosporin]] {{or}} [[dicloxacillin]] {{or}} [[clindamycin]]
::* '''Mild (typical cellulitis/erysipelas with no focus of purulence)'''
:*Moderate : Typical cellulitis/erysipelas with systemic signs of infection
:::* Preferred regimen (1): [[Penicillin VK]] 500 mg PO bid
::*Preferred treatment : [[Pencillin]] VK {{or}} [[ceftriaxone]] {{or}} [[cefazolin]] {{or}} [[clindamycin]]
:::* Preferred regimen (2): [[Cephalosporin]]  
:*Severe : patients who have failed incision and drainage plus oral antibiotics or those with systemic signs of infection such as temperature >38°C, tachycardia (heart rate >90 beats per minute), tachypnea (respiratory rate >24 breaths per minute) or abnormal white blood cell count (<12 000 or <400 cells/µL), or immunocompromised patients  
:::* Preferred regimen (3): [[Dicloxacillin]]  
::*Empiric treatment: [[Vancomycin]] {{and}} [[piperacillin-tazobactam]]
:::* Preferred regimen (4): [[Clindamycin]] 600-900 mg IV q6-8h
 
::* '''Moderate (typical cellulitis/erysipelas with systemic signs of infection)'''
*Purulent :
:::* Preferred regimen (1): [[Penicillin VK]] 500 mg PO bid
:*Mild : Typical cellulitis/erysipelas with no focus of purulence
:::* Preferred regimen (2): [[ceftriaxone]] 1-2 g q4-8h 
::*Preferred treatment : Incision and Drainage
:::* Preferred regimen (3): [[cefazolin]]  
:*Moderate : Typical cellulitis/erysipelas with systemic signs of infection.
:::* Preferred regimen (4): [[clindamycin]] 600-900 mg IV q6-8h
::* '''Severe infection'''
:::* Patients who have failed incision and drainage plus oral antibiotics  
:::* Those with systemic signs of infection such as temperature >38°C,  
:::* Tachycardia (heart rate >90 beats per minute),  
:::* Tachypnea (respiratory rate >24 breaths per minute) or  
:::* Abnormal white blood cell count (<12 000 or <400 cells/µL), or  
:::* Immunocompromised patients  
:::* Preferred regimen: [[Vancomycin]] {{and}} [[piperacillin-tazobactam]]
* '''Purulent Celluitits'''
:* '''Mild (typical cellulitis/erysipelas with no focus of purulence)'''
::* Preferred regimen: Incision and Drainage
:* '''Moderate (typical cellulitis/erysipelas with systemic signs of infection)'''
::* Incision and Drainage
::* Empiric regimen : [[TMP-SMX]] {{or}} [[doxycycline]]
::* MRSA : [[TMP-SMX]]
::* MSSA : [[Dicloxacillin]] {{or}} [[cephalexin]]
:*Severe infection: patients who have failed oral antibiotic regimen or those with systemic signs of infection (as defined above under purulent infection), or those who are immunocompromised, or those with clinical signs of deeper infection such as bullae, skin sloughing, hypotension, or evidence of organ dysfunction.
::*Incision and Drainage
::*Incision and Drainage
::*Empiric treatment : [[TMP-SMX]] {{or}} [[doxycycline]]
::*Empiric regimen : [[Vancomycin]] {{or}} [[daptomycin]] {{or}} [[linezolid]] {{or}} [[televancin]] {{or}} [[ceftaroline]]
::*MRSA : [[TMP-SMX]]
::*MSSA : [[Dicloxacillin]] {{or}} [[cephalexin]]
:*Severe infection: patients who have failed oral antibiotic treatment or those with systemic signs of infection (as defined above under purulent infection), or those who are immunocompromised, or those with clinical signs of deeper infection such as bullae, skin sloughing, hypotension, or evidence of organ dysfunction.
::*Incision and Drainage
::*Empiric treatment : [[Vancomycin]] {{or}} [[daptomycin]] {{or}} [[linezolid]] {{or}} [[televancin]] {{or}} [[ceftaroline]]
::*MRSA : [[Vancomycin]] {{or}} [[daptomycin]] {{or}} [[linezolid]] {{or}} [[televancin]] {{or}} [[ceftaroline]]
::*MRSA : [[Vancomycin]] {{or}} [[daptomycin]] {{or}} [[linezolid]] {{or}} [[televancin]] {{or}} [[ceftaroline]]


===Ecthyma===
===Ecthyma===
:*  '''Methicillin-Susceptible Staphylococcus Aureus'''
::* Preferred regimen (1): [[Dicloxacillin]] 250 mg PO qid for 7 days.
::* Preferred regimen (2): [[Cephalexin]] 250 mg PO qid for 7 days.
:*  '''Methicillin-Resistant Staphylococcus Aureus'''
::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid
::* Preferred regimen (2): [[Clindamycin]] 600 mg every 8 h IV or 300–450 mg PO qid
::* Preferred regimen (3): [[Sulfamethoxazole-trimethoprim]] 25–40 mg/kg/d in 3 divided doses IV or 25–30 mg/kg/d in 3 divided doses PO


===Erysipelas===
===Erysipelas===
* Erysipelas (Adults)
* Erysipelas<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:* Oral therapy
:* 1. '''Adults'''
::* Preferred regimen (1): [[Penicillin]] 500 mg orally every six hours
::* Preferred regimen (1): [[Penicillin]] 500 mg PO qid
::* Preferred regimen (2): [[Amoxicillin]] 500 mg orally every eight hours
::* Preferred regimen (2): [[Amoxicillin]] 500 mg PO qid
::* Preferred regimen (3): [[Erythromycin]] 250 mg orally every six hours
::* Preferred regimen (3): [[Erythromycin]] 250 mg PO qid
::* Preferred regimen (4): [[Ceftriaxone]] 1 g IV q24h
::* Preferred regimen (5): [[Cefazolin]] 1 to 2 g IV q8h


:* Parenteral therapy
:* 2. '''Pediatrics'''
::* Preferred regimen (1): [[Ceftriaxone]] 1g intravenously every 24 hours
::* Preferred regimen (1): [[Penicillin]] 25 to 50 mg/kg/day PO tid or qid
::* Preferred regimen (2): [[Cefazolin]] 1 to 2 g intravenously every eight hours
::* Preferred regimen (2): [[Amoxicillin]] 25 to 50 mg/kg/day PO tid
::* Preferred regimen (3): [[Erythromycin]] 30 to 50 mg/kg/day PO bid to qid
::* Preferred regimen (4): [[Ceftriaxone]] 50 to 75 mg/kg/day IV q12-24h
::* Preferred regimen (5): [[Cefazolin]] 100 mg/kg/day IV q8h


*Erysipelas (pediatrics)
===Erysipeloid===
:* Oral therapy
* Erysipeloid<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
::* Preferred regimen (1): [[Penicillin]] 25 to 50 mg/kg per day orally in three or four doses
:* Preferred regimen (1): [[Penicillin]] 500 mg qid for 7–10 days
::* Preferred regimen (2): [[Amoxicillin]] 25 to 50 mg/kg per day orally in three doses
::* Preferred regimen (3): [[Erythromycin]] 30 to 50 mg/kg per day orally in two to four doses
 
:*Parenteral therapy
::* Preferred regimen (1): [[Ceftriaxone]] 50 to 75 mg/kg per day intravenously in one or two doses
::* Preferred regimen (2): [[Cefazolin]] 100 mg/kg per day intravenously in three doses


===Erysipeloid===
:* Preferred regimen (2): [[Amoxicillin]] 500 mg tid for 7–10 days
:* Preferred regimen: [[Penicillin]] 500 mg qid for 7–10 days {{or}} [[Amoxicillin]] 500 mg tid for 7–10 days


===Erythrasma===
===Erythrasma===
* Erythrasma<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
* Erythrasma<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:* Localized infection
:* '''Localized infection'''
::* Preferred regimen : [[Clindamycin]] Topical bid or tid for 7-14 days
:* '''Widespread infection'''
::* Preferred regimen (1): [[Clarithromycin]] 500 mg PO bid for 14 days


::* Preferred regimen : Topical [[clindamycin]] 2-3 times daily for 7-14 days
::* Preferred regimen (2): [[Erythromycin]] 250 mg PO bid for 14 days
:* Widespread infection
 
::* Preferred regimen : [[clarithromycin]] 500mg PO  bid {{or}} [[erythromycin]] 250mg PO bid for 14 days


===Fournier gangrene===
===Fournier gangrene===
* Fournier gangrene<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:* '''If caused by streptococcus species or clostridia'''
::* Preferred regimen: [[Penicillin G]]
:* '''Polymicrobial'''


::* Preferred regimen: [[Doripenem]] {{or}} [[imipenem]] {{or}} [[meropenem]]
:* '''MRSA (methicillin resistant staphylococcus aureus) suspected'''


 
::* Preferred regimen: [[vancomycin]] {{or}} [[daptomycin]]
* Fournier gangrene<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
 
:* Streptococcus or clostridia : [[Penicillin]] G
:* Polymicrobial : [[Doripenem]] {{or}} [[imipenem]] {{or}} [[meropenem]]
:* MRSA suspected :[[vancomycin]] {{or}} [[daptomycin]]


===Furuncle===
===Furuncle===
* Furuncle<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
* Furuncle<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>


:* Mild   : Incision and Drainage
:* '''Mild'''
:* Moderate  
::* Preferred regimen: Incision and Drainage
:* '''Moderate'''
::* Empiric treatment :[[TMP-SMX]] {{or}} [[Doxycycline]]
::* Empiric treatment :[[TMP-SMX]] {{or}} [[Doxycycline]]
::*Culture directed treatment
::* '''Culture directed treatment'''
:::* MSSA : [[TMP-SMX]]
:::* MSSA (methicilin susceptible staphylococcus aureus): [[TMP-SMX]]
:::* MRSA : [[dicloxacillin]] {{or}} [[cephalexin]]
:::* MRSA (methicilin resistant staphylococcus aureus): [[dicloxacillin]] {{or}} [[cephalexin]]
:* Severe
:* '''Severe'''
::*Empiric treatment :[[Vancomycin]] {{or}} [[daptomycin]] {{or}} [[linezolid]] {{or}} [[televancin]] {{or}} [[ceftaroline]]
::* Empiric treatment :[[Vancomycin]] {{or}} [[daptomycin]] {{or}} [[linezolid]] {{or}} [[televancin]] {{or}} [[ceftaroline]]
::*Culture directed treatment
::* Culture directed treatment
:::* MSSA : [[Nafcillin]] {{or}} [[cefazolin]] {{or}} [[clindamycin]]
:::* MSSA (methicilin susceptible staphylococcus aureus): [[Nafcillin]] {{or}} [[cefazolin]] {{or}} [[clindamycin]]
:::* MRSA :[[Vancomycin]] {{or}} [[daptomycin]] {{or}} [[linezolid]] {{or}} [[televancin]] {{or}} [[ceftaroline]]
:::* MRSA (methicilin resistant staphylococcus aureus): [[Vancomycin]] {{or}} [[daptomycin]] {{or}} [[linezolid]] {{or}} [[televancin]] {{or}} [[ceftaroline]]


===Gas gangrene===
===Gas gangrene===
* Empiric antimicrobial therapy
* Gas gangrene<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:* Preferred regimen : [[vancomycin]]1gm IV q12h {{and}} ([[piperacillin-tazobactam]]3.375 gm q6h {{or}} [[ampicillin-sulbactam]]3 gm IV q6h {{or}} [[carbapenem]])
:* 1. '''Empiric antimicrobial therapy'''
* Culture directed antimicrobial therapy
::* Preferred regimen (1): [[Vancomycin]] 1 g IV q12h {{and}} ([[Piperacillin-tazobactam]] 3.375 g q6h  
:* Clostridium perfringens
 
::* Preferred regimen   : [[penicillin]] G 24 million units/day divided q4-6h IV {{and}} [[clindamycin]] 900 mg IV q8h
::* Preferred regimen (2): [[Vancomycin]] 1 g IV q12h {{and}} [[Ampicillin-sulbactam]] 3 g IV q6h  
::* Alternative regimen : [[erythromycin]]1 gm q6h IV {{or}} [[ceftriaxone]] 2gm IV q12h
 
::* Preferred regimen (2): [[Vancomycin]] 1 g IV q12h {{and}} [[Carbapenem]])
:* 2. '''Culture directed antimicrobial therapy'''
::* 2.1 '''Clostridium perfringens'''
:::* Preferred regimen: [[Penicillin G]] 24 MU/day IV q4-6h {{and}} [[Clindamycin]] 900 mg IV q8h
:::* Alternative regimen (1): [[Erythromycin]] 1 g IV q6h
:::* Alternative regimen (2): [[Ceftriaxone]] 2 g IV q12h


===Glanders===
===Glanders===
* '''Glanders'''
*'''Glanders'''<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:* Preferred regimen: [[Ceftazidime]] {{or}} [[Gentamicin]] {{or}} [[Imipenem]] {{or}} [[Doxycycline]] {{or}} [[Ciprofloxacin]] is recommended based on in vitro susceptibility
:* Preferred regimen: [[Ceftazidime]] {{or}} [[Gentamicin]] {{or}} [[Imipenem]] {{or}} [[Doxycycline]] {{or}} [[Ciprofloxacin]] is recommended based on in vitro susceptibility
===Impetigo===
* Impetigo, adult
:* Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and β-hemolytic streptococci)
::* '''Limited number of lesions'''
:::* Preferred regimen: [[Mupirocin]] topically bid for 5 days {{or}} [[Retapamulin]] topically bid for 5 days
::* '''Numerous lesions or outbreaks of post streptococcal glomerulonephritis'''
:::* Preferred regimen: [[Dicloxacillin]] 250 mg PO qid for 7 days {{or}} [[Amoxicillin-Clavulanate]] 875/125 mg PO bid for 7 days {{or}} [[Cephalexin]] 250 mg PO qid for 7 days
:::* Alternative regimen (for penicillin-allergic patients): [[Doxycycline]] 100 mg PO bid for 7 days {{or}} [[Clindamycin]] 300–400 mg PO qid for 7 days {{or}} [[Sulfamethoxazole-Trimethoprim]] 1–2 double-strength tablets PO bid for 7 days
:* Culture-directed antimicrobial therapy
::* '''Streptococcus alone'''
:::* Preferred regimen: [[Penicillin V]] 250–500 mg PO qid for 7 days
:::* Alternative regimen (for penicillin-allergic patients): [[Erythromycin]] 250 mg PO qid for 7 days {{or}} [[Clindamycin]] 300–400 mg PO qid for 7 days
::* '''Methicillin-resistant Staphylococcus aureus'''
:::* Preferred regimen: [[Doxycycline]] 100 mg PO bid for 7 days {{or}} [[Clindamycin]] 300–450 mg PO qid for 7 days {{or}} [[Sulfamethoxazole-Trimethoprim]] 1–2 double-strength tablets PO bid for 7 days
* Impetigo, pediatric
:* Empiric antimicrobial therapy (covering methicillin-susceptible Staphylococcus aureus and β-hemolytic streptococci)
::* '''Limited number of lesions'''
:::* Preferred regimen: [[Mupirocin]] topically bid for 5 days {{or}} [[Retapamulin]] topically bid for 5 days
::* '''Numerous lesions or outbreaks of poststreptococcal glomerulonephritis'''
:::* Preferred regimen: [[Amoxicillin-Clavulanate]] 25 mg/kg/day of amoxicillin component PO bid for 7 days {{or}} [[Cephalexin]] 25–50 mg/kg/day PO tid–qid for 7 days
:::* Alternative regimen (for penicillin-allergic patients): [[Clindamycin]] 25–30 mg/kg/day PO tid for 7 days {{or}} [[Sulfamethoxazole-Trimethoprim]] 8–12 mg/kg/day PO bid for 7 days
:* Culture-directed antimicrobial therapy
::* '''Streptococcus alone'''
:::* Preferred regimen: [[Penicillin V]] 60,000–100,000 U/kg PO qid for 7 days
:::* Alternative regimen (for penicillin-allergic patients): [[Erythromycin]] 40 mg/kg/day PO tid–qid for 7 days {{or}} [[Clindamycin]] 20 mg/kg/day PO tid for 7 days
::* '''Methicillin-resistant Staphylococcus aureus'''
:::* Preferred regimen: [[Clindamycin]] 25–30 mg/kg/day PO tid for 7 days {{or}} [[Sulfamethoxazole-Trimethoprim]] 8–12 mg/kg/day PO bid for 7 days


===Mastitis===
===Mastitis===
:*  Preferred regimen (1): [[Amoxicillin]]/[[clavulanate]] (Augmentin), 875 mg twice daily
*Mastitis<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:*  Preferred regimen (2): [[Cephalexin]] (Keflex),500 mg four times daily
:*  Preferred regimen (1): [[Amoxicillin-clavulanate]] 875 mg PO bid
:*  Preferred regimen (3): [[Ciprofloxacin]] (Cipro),500 mg twice daily
:*  Preferred regimen (2): [[Cephalexin]] 500 mg PO qid
:*  Preferred regimen (4): [[Clindamycin]] (Cleocin),300 mg four times daily
:*  Preferred regimen (3): [[Ciprofloxacin]] 500 mg PO bid
:*  Preferred regimen (5): [[Dicloxacillin]] (Dynapen, brand no longer available in the United States), 500 mg four times daily
:*  Preferred regimen (4): [[Clindamycin]] 300 mg PO qid
:*  Preferred regimen (6): [[Trimethoprim]]/[[sulfamethoxazole]] (Bactrim, Septra),*† 160 mg/800 mg twice daily
:*  Preferred regimen (5): [[Dicloxacillin]] 500 mg PO qid
:*  Preferred regimen (6): [[Trimethoprim-sulfamethoxazole]] 160 mg/800 mg PO bid


===Necrotizing fasciitis===
===Necrotizing fasciitis===
* '''Mixed infections, adult'''
* Necrotizing fasciitis<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:* Preferred regimen (1): [[Piperacillin-tazobactam]] 3.37 g every 6–8 h IV {{and}} [[vancomycin]] IV 30 mg/kg/d in 2 divided doses (Severe [[Pencillin]] allergy: [[Clindamycin]] or [[metronidazole]] with an [[aminoglycoside]] or [[fluoroquinolone]])
:* 1. '''Mixed infections'''  
:* Preferred regimen (2): [[Imipenem]]-[[cilastatin]] 1 g every 6–8 h IV
::* 1.1 '''Adults'''
:* Preferred regimen (3): [[Meropenem]] 1 g every 8 h IV
:::* Preferred regimen (1): [[Piperacillin-tazobactam]] 3.37 g IV q6–8h {{and}} [[Vancomycin]] 30 mg/kg/day IV q12h
:* Preferred regimen (4): [[Ertapenem]] 1 g daily IV
:::* Note: In case of severe pencillin allergy, use clindamycin or metronidazole with an aminoglycoside or fluoroquinolone
:* Preferred regimen (5): [[Cefotaxime]]2 g every 6 h IV {{and}} ([[metronidazole]]500 mg every 6 h IV {{or}} [[clindamycin]]600–900 mg every 8 h IV)
:::* Preferred regimen (2): [[Imipenem]]-[[cilastatin]] 1 g IV q6–8h
* '''Mixed infections, pediatric'''
:::* Preferred regimen (3): [[Meropenem]] 1 g IV q8h
:* Preferred regimen (1): [[Piperacillin-tazobactam]] 60–75 mg/kg/dose of the [[piperacillin]] component every 6 h IV {{and}} [[vancomycin]] 10–13 mg/kg/dose every 8 h IV (Severe Pencillin allergy: [[Clindamycin]] or [[metronidazole]] with an [[aminoglycoside]] or [[fluoroquinolone]])
:::* Preferred regimen (4): [[Ertapenem]] 1 g IV q24h
:* Preferred regimen (2): [[Meropenem]] 20 mg/kg/dose every 8 h IV
:::* Preferred regimen (5): [[Cefotaxime]] 2 g IV q6h {{and}} [[Metronidazole]] 500 mg IV q6h
:* Preferred regimen (3): [[Ertapenem]] 15 mg/kg/dose every 12 h IV for children 3 mo-12 y
:::* Preferred regimen (6): [[Cefotaxime]] 2 g IV q6h {{and}} [[Clindamycin]] 600–900 mg IV q8h
:* Preferred regimen (4): [[Cefotaxime]]50 mg/kg/dose every 6 h IV{{and}} ([[metronidazole]]7.5 mg/kg/dose every 6 h IV{{or}} [[clindamycin]]10–13 mg/kg/dose every 8 h IV)
::* 1.2 '''Pediatrics'''
* '''Streptococcus, adult'''
:::* Preferred regimen (1): [[Piperacillin-tazobactam]] 60–75 mg/kg/dose of the [[Piperacillin]] component IV q6h {{and}} [[Vancomycin]] 10–13 mg/kg/dose IV q8h
:* Preferred regimen: [[Penicillin]] 2–4 million units every 4–6 h IV (adult) {{and}} [[clindamycin]] 600–900 mg every 8 h IV (Severe Pencillin allergy: [[Vancomycin]], [[linezolid]], [[quinupristin]]/[[dalfopristin]], [[daptomycin]])
:::* Note: Severe pencillin allergy, use clindamycin or metronidazole with an aminoglycoside or fluoroquinolone)
* '''Streptococcus, pediatric'''
:::* Preferred regimen (2): [[Meropenem]] 20 mg/kg/dose IV q8h
:* Preferred regimen: [[Penicillin]]60 000–100 000 units/kg/dose every 6 h IV {{and}} [[clindamycin]] 10–13 mg/kg/dose every 8 h IV (Severe Pencillin allergy: [[Vancomycin]], [[linezolid]], [[quinupristin]]/[[dalfopristin]], [[daptomycin]])
:::* Preferred regimen (3): [[Ertapenem]] 15 mg/kg/dose IV q12h for children 3 months-12 years
* '''Staphylococcus aureus, adult'''
:::* Preferred regimen (4): [[Cefotaxime]] 50 mg/kg/dose IV q6h {{and}} [[Metronidazole]] 7.5 mg/kg/dose IV q6h
:* Preferred regimen (1): [[Nafcillin]] 1–2 g every 4 h IV (Severe Pencillin allergy: [[Vancomycin]], [[linezolid]], [[quinupristin]]/[[dalfopristin]], daptomycin)
:::* Preferred regimen (5): [[Cefotaxime]] 50 mg/kg/dose IV q6h {{and}} [[Clindamycin]] 10–13 mg/kg/dose IV q8h
:* Preferred regimen (2): [[Oxacillin]] 1–2 g every 4 h IV
:* 2. '''Streptococcus infection'''
:* Preferred regimen (3): [[Cefazolin]] 1 g every 8 h IV
::* 2.1 '''Adults'''
:* Preferred regimen (4): [[Vancomycin]] 30 mg/kg/d in 2 divided doses IV
:::* Preferred regimen: [[Penicillin]] 2–4 MU IV q4–6h {{and}} [[Clindamycin]] 600–900 mg IV q8h
:* Preferred regimen (5): [[Clindamycin]] 600–900 mg every 8 h IV
:::* Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin
* '''Staphylococcus aureus, pediatric'''
::* 2.2 '''Pediatric'''
:* Preferred regimen (1): [[Nafcillin]] 50 mg/kg/dose every 6 h IV (Severe Pencillin allergy: [[Vancomycin]], [[linezolid]], [[quinupristin]]/[[dalfopristin]], [[daptomycin]])
:::* Preferred regimen: [[Penicillin]] 0.06–0.1 MU/kg/dose IV q6h {{and}} [[Clindamycin]] 10–13 mg/kg/dose IV q8h
:* Preferred regimen (2): [[Oxacillin]] 50 mg/kg/dose every 6 h IV
:::* Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin
:* Preferred regimen (3): [[Cefazolin]] 33 mg/kg/dose every 8 h IV
:* 3. '''Staphylococcus aureus'''
:* Preferred regimen (4): [[Vancomycin]] 15 mg/kg/dose every 6 h IV
::* 3.1 '''Adults'''
:* Preferred regimen (5): [[Clindamycin]] 10–13 mg/kg/dose every 8 h IV ([[Bacteriostatic]]; potential cross-resistance and emergence of resistance in [[erythromycin]]-resistant strains; inducible resistance in MRSA)
:::* Preferred regimen (1): [[Nafcillin]] 1–2 g IV q4h
* '''Clostridium species, adult'''
:::* Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin
:* Preferred regimen: [[Clindamycin]] 600–900 mg every 8 h IV {{and}} [[penicillin]] 2–4 million units every 4–6 h IV  
:::* Preferred regimen (2): [[Oxacillin]] 1–2 g IV q4h
* '''Clostridium species, pediatric'''
:::* Preferred regimen (3): [[Cefazolin]] 1 g IV q8h
:* Preferred regimen: [[Clindamycin]] 10–13 mg/kg/dose every 8 h IV {{and}} [[penicillin]] 60 000–100 00 units/kg/dose every 6 h IV  
:::* Preferred regimen (4): [[Vancomycin]] 30 mg/kg/day IV q12h
* '''Aeromonas hydrophila, adult'''
:::* Preferred regimen (5): [[Clindamycin]] 600–900 mg IV q8h
:* Preferred regimen: [[Doxycycline]] 100 mg every 12 h IV {{and}} ([[ciprofloxacin]] 500 mg every 12 h IV {{or}} [[ceftriaxone]] 1 to 2 g every 24 h IV)
::* '''Pediatrics'''
* '''Aeromonas hydrophila, pediatric'''
:::* Preferred regimen (1): [[Nafcillin]] 50 mg/kg/dose IV q6h
(Not recommended for children but may need to use in life-threatening situations)
:::* Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin
* '''Vibrio vulnificus, adult'''
:::* Preferred regimen (2): [[Oxacillin]] 50 mg/kg/dose IV q6h
:* Preferred regimen: [[Doxycycline]] 100 mg every 12 h IV {{and}} [[ceftriaxone]] 1 g qid IV {{or}} [[cefotaxime]] 2 g tid IV
:::* Preferred regimen (3): [[Cefazolin]] 33 mg/kg/dose IV q8h
:::* Preferred regimen (4): [[Vancomycin]] 15 mg/kg/dose IV q6h
:::* Preferred regimen (5): [[Clindamycin]] 10–13 mg/kg/dose IV q8h (bacteriostatic; potential cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA)
:* 4. '''Clostridium species'''
::* 4.1 '''Adults'''
:::* Preferred regimen: [[Clindamycin]] 600–900 mg IV q8h {{and}} [[Penicillin]] 2–4 MU IV q4–6h 
::* 4.2 '''Pediatrics'''
:::*Preferred regimen: [[Clindamycin]] 10–13 mg/kg/dose IV q8h {{and}} [[Penicillin]] 0.06-0.1 MU/kg/dose IV q6h
:* 5. '''Aeromonas hydrophila'''  
::* 5.1 '''Adults'''
:::* Preferred regimen (1): [[Doxycycline]] 100 mg IV q12h {{and}} [[ciprofloxacin]] 500 mg IV q12h
 
:::* Preferred regimen (2): [[Doxycycline]] 100 mg IV q12h {{and}} [[ceftriaxone]] 1 to 2 g IV q24h
::* 5.2 '''Pediatrics'''
:::* Not recommended for children but may need to use in life-threatening situations
:* 6. '''Vibrio vulnificus
::* 6.1 '''Adults'''
:::* Preferred regimen (1): [[Doxycycline]] 100 mg IV q12h {{and}} [[ceftriaxone]] 1 g IV qid
:::* Preferred regimen (2): [[Doxycycline]] 100 mg IV q12h {{and}} [[cefotaxime]] 2 g IV tid


* '''Vibrio vulnificus, pediatric'''
::* 6.2 '''Pediatrics'''
Not recommended for children but may need to use in life-threatening situation
:::* Not recommended for children but may need to use in life-threatening situation


===Pilonidal cyst===
===Pilonidal cyst===
* Preferred regimen : A 5-10 day course of antibiotic active against pathogens isolated.
* Pilonidal cyst<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:* Preferred regimen: After the pathogens isolated, a 5-10 day course of antibiotic is prescribed.


===Pyomyositis===
===Pyomyositis===
* Preferred regimen : [[nafcillin]] {{or}} [[oxacillin]] 2 gm IV q4h {{or}} [[cefazolin]] 2gm IV q8h (If MSSA)
* Pyomyositis<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
* Alternate regimen : [[vancomycin]] 1gm IV q 12h (If MRSA)
:* Preferred regimen (1): [[Nafcillin]]
:* Preferred regimen (2): [[Oxacillin]] 2 g IV q4h  
 
:* Preferred regimen (3): [[Cefazolin]] 2 g IV q8h (if MSSA)
:* Alternate regimen: [[Vancomycin]] 1 g IV q12h (if MRSA)


===Seborrheic dermatitis===
===Seborrheic dermatitis===
* '''Antifungal agents'''
* Seborrheic dermatitis<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:* Preferred regimen (1): [[Ketoconazole]] 2% in shampoo, foam, gel, or cream‡ Scalp: twice/wk for clearance, then once/wk or every other wk for maintenance; other areas: from twice daily to twice/wk for clearance, then from twice/wk to once every other wk for maintenance  
:* 1. '''Antifungal agents'''
:* Preferred regimen (2): [[Bifonazole]] 1% in shampoo or cream Scalp: 3 times/wk for clearance; other areas: once daily for clearance
::* Preferred regimen (1): [[Ketoconazole]] 2% in shampoo, foam, gel, or cream
:* Preferred regimen (3): [[Ciclopirox|Ciclopirox olamine]] (also called ciclopirox) 1.0% or 1.5% in shampoo or cream Scalp: twice to 3 times/wk for clearance, then once/wk or every 2 wk for maintenance; other areas: twice daily for clearance, then once daily for maintenance
:::* Scalp: Twice/week for clearance {{then}} once/week or every other week for maintenance
:::* Other areas: From bid to twice/week for clearance {{then}} from twice/week to once every other week for maintenance  
::* Preferred regimen (2): [[Bifonazole]] 1% in shampoo or cream  
:::* Scalp: 3 times/week for clearance
:::* Other areas: qd for clearance
::* Preferred regimen (3): [[Ciclopirox olamine]] (also called ciclopirox) 1.0% or 1.5% in shampoo or cream  
:::* Scalp: Twice to 3 times/week for clearance {{then}} once/week or every 2 week for maintenance  
:::* Other areas: Twice daily for clearance {{then}} qd for maintenance


* '''Corticosteroids'''  
:* 2. '''Corticosteroids'''  
:* Preferred regimen (1): [[Hydrocortisone]] 1% in cream Areas other than scalp: once or twice daily
::* Preferred regimen (1): [[Hydrocortisone]] 1% in cream areas other than scalp qd or bid
:* Preferred regimen (2): [[Betamethasone dipropionate]] 0.05% in lotion Scalp and other areas: once or twice daily
::* Preferred regimen (2): [[Betamethasone dipropionate]] 0.05% in lotion scalp and other areas qd or bid
:* Preferred regimen (3): [[Clobetasol|Clobetasol 17- butyrate]] 0.05% in cream Areas other than scalp: once or twice daily
::* Preferred regimen (3): [[Clobetasol|Clobetasol 17- butyrate]] 0.05% in cream areas other than scalp qd or bid
:* Preferred regimen (4): [[Clobetasol|Clobetasol dipro- pionate]] 0.05% in shampoo Scalp: twice weekly in a short- contact fashion (up to 10 min application, then washing)
::* Preferred regimen (4): [[Clobetasol|Clobetasol dipro- pionate]] 0.05% in shampoo  
:* Preferred regimen (5): [[Desonide]] 0.05% in lotion Scalp and other areas of skin: twice daily
:::* Scalp: Twice weekly in a short- contact fashion (up to 10 min application, then washing)
::* Preferred regimen (5): [[Desonide]] 0.05% lotion bid on scalp and other areas


* '''Lithium salts'''
:* 3. '''Lithium salts'''
:* Preferred regimen: [[Lithium succinate]] {{and}} [[zinc sulfate]] Ointment containing 8% [[lithium succinate]] plus 0.05% [[zinc sulfate]]
::* Preferred regimen: [[Lithium succinate]] {{and}} [[Zinc sulfate]] Ointment containing 8% [[Lithium succinate]] {{and}} 0.05% [[Zinc sulfate]]
:* Preferred regimen: [[Lithium|Lithium gluconate]] 8% in gel Areas other than scalp: twice daily
::* Preferred regimen: [[Lithium|Lithium gluconate]] 8% in gel bid on areas other than scalp


===Skin and soft tissue infection in neutropenic fever===
===Skin and soft tissue infection in neutropenic fever===
*Initial episode  
* '''Treatment of skin and soft tissue infection in neutropenic fever'''<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:*Empiric treatment : [[vancomycin]] {{and}} ([[Carbapenem]] {{or}} [[imipenem]] {{or}} [[meropenem]] {{or}} [[doripenem]] {{or}} [[piperacillin-tazobactam]])
:* 1. '''Initial episode'''
*Recurrent or persistent
::* Empiric treatment : [[Vancomycin]] {{and}} ([[Carbapenem]] {{or}} [[Imipenem]] {{or}} [[Meropenem]] {{or}} [[Doripenem]] {{or}} [[Piperacillin-Tazobactam]])
:*Empiric treatment :
:* 2. '''Recurrent or persistent'''
:* Antibacterial
::* Empiric treatment  
::*Preferred treatment : [[Vancomycin]] 30–60 mg/kg/d IV in 2–4 divided doses (Target serum trough concentrations of 15–20 µg/mL in severe infections)
:::* 2.1 '''Antibacterial therapy'''
::*Preferred treatment : [[Daptomycin]] 4–6 mg/kg/d IV (Covers VRE, strains nonsusceptible to vancomycin may be cross-resistant to daptomycin)
::::* Preferred regimen (1): [[Vancomycin]] 30–60 mg/kg/day IV in 2–4 divided doses (Target serum trough concentrations of 15–20 µg/mL in severe infections)
::*Preferred treatment : [[Linezolid]] 600 mg every 12 h IV (100% oral bioavailability; so oral dose same as IV dose. Covers VRE and MRSA)
::::* Preferred regimen (2): [[Daptomycin]] 4–6 mg/kg/day IV (Covers VRE, strains nonsusceptible to vancomycin may be cross-resistant to daptomycin)
 
::::* Preferred regimen (3): [[Linezolid]] 600 mg q12h IV (100% oral bioavailability; so oral dose same as IV dose. Covers VRE and MRSA)
::*Preferred treatment : [[Colistin]] 5 mg/kg load, then 2.5 mg/kg every 12 h IV (Nephrotoxic; does not cover gram-positives or anaerobes, Proteus, Serratia, Burkholderia)
::::* Preferred regimen (4): [[Colistin]] 5 mg/kg IV loaing dose, {{then}} 2.5 mg/kg q12h IV (Nephrotoxic; does not cover gram-positives or anaerobes, Proteus, Serratia, Burkholderia)
 
:::* 2.2 '''Antifungal therapy'''
:* Antifungal
::::* Preferred regimen (1): [[Fluconazole]] 100–400 mg PO q24h {{or}} [[Fluconazole]] 800 mg IV loading dose, {{then}} 400 mg qd (Candida krusei and Candida glabrata are resistant)
::*Preferred treatment : [[Fluconazole]] 100–400 mg PO every 24 h {{or}} 800 mg IV loading dose, then 400 mg daily (Candida krusei and Candida glabrata are resistant)
::::* Preferred regimen (2): [[Voriconazole]] 400 mg PO  bid in 2 doses, then 200 mg q12h {{or}} [[Voriconazole]] 6 mg/kg IV q12h for 2 doses, {{then}} 4 mg/kg IV q12h (Accumulation of cyclodextrin vehicle with IV formulation with renal insufficiency)
::*Preferred treatment : [[Voriconazole]] 400 mg bid × 2 doses PO , then 200 mg every 12 h {{or}} 6 mg/kg IV every 12 h for 2 doses, followed by 4 mg/kg IV every 12 h (Accumulation of cyclodextrin vehicle with IV formulation with renal insufficiency)
::::* Preferred regimen (3): [[Posaconazole]] 400 mg PO bid with meals (Covers Mucorales)
::*Preferred treatment : [[Posaconazole]] 400 mg bid PO with meals (Covers Mucorales)
::::* Preferred regimen (4): Lipid complex [[Amphotericin-B]] 5 mg/kg/day IV (Not active against fusaria)
::*Preferred treatment : Lipid complex [[amphotericin]] B 5 mg/kg/d IV (Not active against fusaria)
::::* Preferred regimen (5): Liposomal [[Amphotericin-B]] 3–5 mg/kg/day IV (Not active against fusaria)
::*Preferred treatment : Liposomal [[amphotericin]] B 3–5 mg/kg/d IV (Not active against fusaria)
:* Culture directed antimicrobial therapy
:*Culture directed antimicrobial therapy
::* Candida
::*Candida
::* Aspergillus
::*Aspergillus
::* Fusarium
::*Fusarium
::* Dissemianted HSV or VZV
::*Dissemianted HSV or VZV


===Skin and soft tissue infection in  cellular immunodeficiency===
===Skin and soft tissue infection in  cellular immunodeficiency===
*Skin and soft tissue infection in neutropenic fever<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
*Empiric treatment :
*Empiric treatment :
:*Antibiotics,  antifungal, antivirals should be considered in life threatening situtations
:*Antibiotics,  antifungal, antivirals should be considered in life threatening situtations
Line 353: Line 395:


===Surgical site infection===
===Surgical site infection===
* '''Surgery of intestinal or genitourinary tract'''
:* Single-drug regimens
::* Preferred regimen (1): [[Ticarcillin-clavulanate]] 3.1 g every 6 h IV
::* Preferred regimen (2): [[Piperacillin-tazobactam]] 3.375 g every 6 h {{or}} 4.5 g every 8 h IV
::* Preferred regimen (3): [[Imipenem]]-[[cilastatin]] 500 mg every 6 h IV
::* Preferred regimen (4): [[Meropenem]] 1 g every 8 h IV
::* Preferred regimen (5): [[Ertapenem]] 1 g every 24 h IV
:* Combination regimens
::* Preferred regimen (1): [[Ceftriaxone]] 1 g every 24 h {{and}} [[metronidazole]] 500 mg every 8 h
::* Preferred regimen (2): IV [[Ciprofloxacin]] 400 mg IV every 12 h or 750 mg po every 12 h {{and}} [[metronidazole]] 500 mg every 8 h
::* Preferred regimen (3): IV [[Levofloxacin]] 750 mg IV every 24 h {{and}} [[metronidazole]] 500 mg every 8 h
::* Preferred regimen (4): IV [[Ampicillin-sulbactam]] 3 g every 6 h {{and}} [[gentamicin]] {{or}} [[tobramycin]] 5 mg/kg every 24 h IV


* '''Surgery of trunk or extremity away from axilla or perineum'''
* '''Surgical site infection treatment'''<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:* Preferred regimen (1): [[Oxacillin]] or [[nafcillin]] 2 g every 6 h IV  
:* 1. '''Surgery of intestinal or genitourinary tract'''
:* Preferred regimen (2): [[Cefazolin]] 0.5–1 g every 8 h IV  
::* 1.1 '''Single-drug regimens'''
:* Preferred regimen (3): [[Cephalexin]] 500 mg every 6 h po
:::* Preferred regimen (1): [[Ticarcillin-clavulanate]] 3.1 g IV q6h
:* Preferred regimen (4): [[SMX-TMP]] 160–800 mg po every 6 h
:::* Preferred regimen (2): [[Piperacillin-tazobactam]] 3.375 g IV q6h {{or}} [[Piperacillin-tazobactam]] 4.5 g IV q8h
:* Preferred regimen (5): [[Vancomycin]] 15 mg/kg every 12 h IV
:::* Preferred regimen (3): [[Imipenem]]-[[cilastatin]] 500 mg IV q6h
:::* Preferred regimen (4): [[Meropenem]] 1 g IV q8h
:::* Preferred regimen (5): [[Ertapenem]] 1 g IV q24h
::* 1.2 '''Combination regimens'''
:::* Preferred regimen (1): [[Ceftriaxone]] 1 g IV q24h {{and}} [[metronidazole]] 500 mg IV q8h
:::* Preferred regimen (2): [[Ciprofloxacin]] 400 mg IV q12h (or [[Ciprofloxacin]] 750 mg IV PO q12h) {{and}} [[metronidazole]] 500 mg IV q8h
:::* Preferred regimen (3): [[Levofloxacin]] 750 mg IV q24h {{and}} [[metronidazole]] 500 mg IV q8h
:::* Preferred regimen (4): [[Ampicillin-sulbactam]] 3 g IV q6h {{and}} [[gentamicin]] ({{or}} [[tobramycin]] 5 mg/kg IV q24h)


* '''Surgery of axilla or perineum'''  
:* 2. '''Surgery of trunk or extremity away from axilla or perineum'''
:* Preferred regimen: [[Metronidazole]] 500 mg every 8 h IV {{and}} ([[Ciprofloxacin]] 400 mg IV every 12 h {{or}} [[Ciprofloxacin]] 750 mg po every 12 h {{or}} [[Levofloxacin]] 750 mg every 24 h IV/PO {{or}} [[Ceftriaxone]] 1 g every 24 h)
::* Preferred regimen (1): [[Oxacillin]] or [[nafcillin]] 2 g IV q6h
::* Preferred regimen (2): [[Cefazolin]] 0.5–1 g IV q8h
::* Preferred regimen (3): [[Cephalexin]] 500 mg PO q6h
::* Preferred regimen (4): [[SMX-TMP]] 160–800 mg PO q6h
::* Preferred regimen (5): [[Vancomycin]] 15 mg/kg IV q12h
 
:* 3. '''Surgery of axilla or perineum'''  
::* Preferred regimen (1): [[Metronidazole]] 500 mg IV q8h {{and}} [[Ciprofloxacin]] 400 mg IV q12h ({{or}} [[Ciprofloxacin]] 750 mg PO q12h)
::* Preferred regimen (2): [[Metronidazole]] 500 mg IV q8h {{and}} [[Levofloxacin]] 750 mg IV/PO q24h
 
::* Preferred regimen (3): [[Metronidazole]] 500 mg IV q8h {{and}} [[Ceftriaxone]] 1 g q24h


===Tularemia===
===Tularemia===
* '''Tularemia'''
* '''Tularemia treatment'''<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:* Preferred regimen (1): [[Streptomycin]] 15 mg/kg every 12 hours IM {{or}} [[Gentamicin]] 1.5 mg/kg every 8 hours IV
:* Preferred regimen (1): [[Streptomycin]] 15 mg/kg IM q12h {{or}} [[Gentamicin]] 1.5 mg/kg IV q8h
:* Preferred regimen (2): [[Tetracycline]] 500 mg qid {{or}} [[doxycycline]] 100 mg bid PO (for mild cases)
:* Preferred regimen (2): [[Tetracycline]] 500 mg qid {{or}} [[doxycycline]] 100 mg bid PO (for mild cases)


===Vascular insufficieny ulcer===
=== Ulcerated skin: Venous/Arterial Insufficiency; Pressure with Secondary Infection (Infected Decubiti)===
* Preferred regimen : [[Imipenem]] 0.5 gm IV q6hr {{or}} [[meropenem]] 1gm IV q24 hr {{or}} [[doripenem]] 500mg IV q8hr {{or}} [[ticarcillin-clavulanate]] 3.1gm IV q8hr {{or}} [[piperacillin-tazobactam]] 3.375gm IV q6hr {{or}} [[ertapenem]] 1gm IV q24hr
* Ulcerated skin: venous/arterial insufficiency; pressure with secondary infection (infected decubiti) treatment<ref name="pmid24126647">{{cite journal| author=Greer N, Foman NA, MacDonald R, Dorrian J, Fitzgerald P, Rutks I et al.| title=Advanced wound care therapies for nonhealing diabetic, venous, and arterial ulcers: a systematic review. | journal=Ann Intern Med | year= 2013 | volume= 159 | issue= 8 | pages= 532-42 | pmid=24126647 | doi=10.7326/0003-4819-159-8-201310150-00006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24126647  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24347199 Review in: Evid Based Med. 2014 Jun;19(3):91] </ref>
:* Preferred regimen (1): [[Imipenem]] 0.5 g IV q6h ({{or}} [[Meropenem]] 1 g IV q24h {{or}} [[Doripenem]] 500 mg IV q8h)
:* Preferred regimen (2): [[Ticarcillin-Clavulanate]] 3.1 g IV q8h
:* Preferred regimen (3): [[Piperacillin-Tazobactam]] 3.375 g IV q6h
:* Preferred regimen (4): [[Ertapenem]] 1 g IV q24h
:* Alternative regimen (1): [[Ciprofloxacin]] 500 mg PO bid {{or}} [[Levofloxacin]] PO 500 mg qd {{and}} [[Metronidazole]] 500 mg PO qid
:* Alternative regimen (2): [[Cefepime]] 2 g IV q12h {{or}} [[Ceftazidime]] 2 g IV q8h {{and}} [[Metronidazole]] 500 mg PO qid
:* Note (1): If gram positive cocci on gram stain add [[Vancomycin]].
:* Note (2): If the ulcer is inflamed, treat with parenteral antibiotics with no topical treatment.
:* Note (3): If the ulcer is not clinically inflamed, consider debridement, removal of foreign body, reduce the pressure for weight bearing limbs and leg elevation.
:* Note (4): If not inflamed, healing improved on air bed, protein supplement, radiant heat and electric stimulation.
:* Note (5): Avoid [[chlorhexidine]] and [[povidone iodine]] as it may harm the granulation tissue.


===Vibrio infection===
===Vibrio infection===
* Vibrio infection<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:* '''Vibrio vulnificus in adults'''
::* Preferred regimen: [[Doxycycline]] 100 mg IV q12h {{and}} [[ceftriaxone]] 1 g IV qid  {{or}} [[cefotaxime]] 2 g IV tid
::* Note: Antibiotic treatment is not recommended for children but may need to use in life-threatening situation


===Wound infection===
===Wound infection===
* Mild to moderate
* '''Wound infection'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:* Preferred regimen : [[TMP-SMX]] double strength 1-2 tabs PO bid {{or}} [[clindamycin]] 300-450 mg PO tid
:* 1. '''Mild to moderate'''
:* Alternate regimen : [[Minocycline]] 100mg PO bid {{or}} [[linezolid]] 600mg PO bid
::* Preferred regimen (1): [[TMP-SMX]]-DS double strength 1-2 tabs PO bid  
* Febrile with sepsis
::* Preferred regimen (2): [[Clindamycin]] 300-450 mg PO tid
:* Preferred regimen : [[Ticarcillin-clavulanate]] 3.1 gm IV q4-6hr {{or}} [[piperacillin-tazobactam]] 3.375 gm q 6hr {{or}} [[doripenem]]500 mg IV q 8hr {{or}} [[imipenem]] {{or}} [[meropenem]] {{or}} [[ertapenem]] 1gm IV q24 hr) {{and}} [[vancomycin]] 1gm IV q12h
::* Alternative regimen (1): [[Minocycline]] 100 mg PO bid  
:* Alternate regimen : [[vancomycin]] 1gm IV q12h {{or}} [[daptomycin]] 6mg/kg iv q24h {{or}} [[ceftaroline]] 600mg IV q12h {{or}} [[telavancin]] 10mg/kg IV q24h {{and}} ([[ciprofloxacin]] {{or}} [[levofloxacin]] 750mg IV q24h)
::* Alternative regimen (2): [[Linezolid]] 600 mg PO bid
:* 2. '''Febrile with sepsis'''
::* Preferred regimen (1): [[Ticarcillin-clavulanate]] 3.1 g IV q4-6h ({{or}} [[Piperacillin-Tazobactam]] 3.375 g q6h) {{and}} [[Vancomycin]] 1g IV q12h
::* Preferred regimen (2): [[Doripenem]] 500 mg IV q 8hr ({{or}} [[Imipenem]] {{or}} [[Meropenem]] {{or}} [[Ertapenem]] 1g IV q24h) {{and}} [[Vancomycin]] 1g IV q12h
::* Alternative regimen (1): [[Vancomycin]] 1 g IV q12h ({{or}} [[Daptomycin]] 6 mg/kg IV q24h) {{and}} [[Ciprofloxacin]] 750 mg IV q24h ({{or}} [[Levofloxacin]] 750 mg IV q24h)
::* Alternative regimen (2): [[Ceftaroline]] 600 mg IV q12h {{and}} [[Ciprofloxacin]] 750 mg IV q24h ({{or}} [[Levofloxacin]] 750 mg IV q24h)
::* Alternative regimen (3): [[Telavancin]] 10 mg/kg IV q24h {{and}} [[Ciprofloxacin]] 750 mg IV q24h ({{or}} [[Levofloxacin]] 750 mg IV q24h)


===Yaws===
===Yaws===
:*  Preferred regimen (1): [[Phenoxymethylpenicillin]] 7–10 d; 12.5 mg/kg q6h (maximum dose, 300 mg q6h)
*Yaws<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:*  Preferred regimen (2): [[Tetracyclines]] 15 d; [[tetracycline]] 500 mg q6h or [[doxycycline]] 100 mg q12h Alternative agents for the treatment of yaws in nonpregnant adults  
:*  Preferred regimen (1): [[Phenoxymethylpenicillin]] 12.5 mg/kg q6h 7-10days (maximum dose, 300 mg q6h)
:*  Preferred regimen (3): [[Erythromycin]] 15 d; 8–10 mg/kg q6h
:*  Preferred regimen (2): [[Tetracyclines]] 500 mg q6h 15 days or [[doxycycline]] 100 mg q12h (alternative agents for the treatment of yaws in nonpregnant adults)
:*  Preferred regimen (4): [[Azithromycin]] Single-dose; 30 mg/kg (maximum dose 2 g)
:*  Preferred regimen (3): [[Erythromycin]] 8–10 mg/kg 15 days q6h
:*  Preferred regimen (4): [[Azithromycin]] 30 mg/kg single-dose (maximum dose 2 g)
 
==References==
{{reflist|2}}

Latest revision as of 16:25, 17 August 2015

Acne vulgaris

  • Acne vulgaris[1]
  • Earliest form, no inflammation
  • Preferred regimen: Tretinoin (cream 0.025 or 0.05%) Topical qd OR (gel 0.01 or 0.025%) qd
  • Alternative regimen (1): Adapalene 0.1 % gel Topical qd
  • Alternative regimen (2): Azelaic acid 20% cream Topical qd
  • Alternative regimen (3): Tazarotene 0.1% cream Topical qd
  • Note: Expect 40–70% decrease in comedones in 12 weeks
  • Mild inflammation
  • Moderate to severe inflammation
  • Preferred regimen (1): Erythromycin 3% Topical AND Benzoyl peroxide 5% bid ± oral antibiotic
  • Preferred regimen (2): Isotretinoin 0.1–1 mg/kg IV qd for 4–5 months for severe widespread nodular cystic lesions that fail oral antibiotic treatment
  • Alternative regimen (2):Minocycline 50 mg PO bid OR Minocycline 1 mg/kg expensive extended release qd
  • Note: Other alternatives include tetracycline, erythromycin, TMP-SMX, clindamycin

Acne rosacea

  • Acne rosacea [2]
  • 1. Facial erythema
  • Preferred regimen: Brimonidine gel Topical bid, applied to the affected area
  • 2. Papulopustular rosacea

Anthrax, cutaneous

  • 1. Cutaneous anthrax[3]
  • Preferred regimen (3): Levofloxacin 500 mg IV/PO qd for 60 days is recommended for bioterrorism cases because of presumed aerosol exposure

Bacillary angiomatosis

  • Bacillary angiomatosis[4]
  • Preferred regimen (1): Erythromycin 500 mg PO qid for 2 weeks to 2 months
  • Preferred regimen (2): Doxycycline 100 mg PO bid for 2 weeks to 2 months
  • 1. Management of Treatment Failure[5]
  • In immunocompromised patients with relapse, retreatment should be continued for 4--6 months; repeated relapses should be treated indefinitely
  • Among patients whose Bartonella infections fail to respond to initial treatment, one or more of the second-line regimens should be considered
  • 2. Prevention of Recurrence[5]
  • Relapses in bone and skin have been reported and are more common when antibiotics are administered for a shorter time (<3 months)
  • For an immunocompromised HIV-infected adult experiencing relapse, long-term suppression of infection with doxycycline or a macrolide is recommended as long as the CD4 cell count is <200 cells/mm3

Bite wounds

  • Animal bite
  • Preferred regimen (1): Amoxicillin-clavulanate 875/125 mg PO bid (some gram-negative rods are resistant; misses MRSA)
  • Preferred regimen (2): Ampicillin-sulbactam 1.5–3.0 g IV q6–8 h (some gram-negative rods are resistant; misses MRSA)
  • Preferred regimen (3): Piperacillin-tazobactam 3.37 g IV q6–8 h (misses MRSA)
  • Preferred regimen (4): Doxycycline 100 mg PO bid OR 100 mg IV q12h (excellent activity against Pasteurella multocida; some streptococci are resistant)
  • Preferred regimen (5): Penicillin AND Dicloxacillin 500 mg PO
  • Preferred regimen (6): Trimethoprim-Sulfamethoxazole 160–800 mg PO bid OR 5–10 mg/kg IV q24h of TMP component (good activity against aerobes; poor activity against anaerobes)
  • Preferred regimen (7): Metronidazole 250–500 mg PO tid OR 500 mg IV q8h (Good activity against anaerobes; no activity against aerobes)
  • Preferred regimen (8): Clindamycin 300 mg PO tid OR 600 mg IV q6–8h (Good activity against staphylococci, streptococci, and anaerobes; misses P. multocida)
  • Preferred regimen (9): Cefuroxime 500 mg PO bid OR 1 g IV q12h
  • Preferred regimen (10): Cefoxitin 1 g IV q6–8h
  • Preferred regimen (11): Ceftriaxone 1 g IV q12h
  • Preferred regimen (12): Cefotaxime 1–2 g IV q6–8h
  • Preferred regimen (13): Ciprofloxacin 500–750 mg PO bid OR 400 mg IV q12h
  • Preferred regimen (14): Levofloxacin 750 mg PO qdOR 750 mg IV q24h
  • Preferred regimen (15): Moxifloxacin 400 mg PO qd OR 400 mg IV q24h (monotherapy good for anaerobes also)
  • Human bite
  • Preferred regimen (1): Amoxicillin-clavulanate 875/125 mg PO bid (some gram-negative rods are resistant; misses MRSA)
  • Preferred regimen (2): Ampicillin-sulbactam 1.5–3.0 g IV q6h (some gram-negative rods are resistant; misses MRSA)
  • Preferred regimen (3): Doxycycline 100 mg PO bid (good activity against eikenella species, staphylococci, and anaerobes; some streptococci are resistant)

Lyme disease, cutaneous

  • Lyme disease[6]
  • 1. Adults
  • 2. Pediatrics
  • Preferred regimen (1): Amoxicillin 50 mg/kg/day PO tid (maximum, 500 mg/dose)
  • Preferred regimen (2): For children aged 8 years, 4 mg/kg/day PO bid (maximum, 100 mg/dose)
  • Note: Doxycycline Not recommended for children aged 8 years.
  • Preferred regimen (3): Cefuroxime axetil 30 mg/kg/day PO bid (maximum, 500 mg/dose)
  • Preferred regimen (4): Ceftriaxone 50–75 mg/kg/day IV q24h (maximum, 2 g)
  • Alternative regimen (1): Doxycycline PO (4 mg/kg in children < 8 years of age)
  • Alternative regimen (2): Cefotaxime 150–200 mg/kg/day IV q6-8h (maximum, 6 g/day)
  • Alternative regimen (3): Penicillin G 0.2–0.4 MU/kg/day q4h (not to exceed 18–24 MU/day)

Bubonic plague

  • Bubonic Plague[6]

Carbuncle

  • Mild
  • Preferred treatment: Incision and Drainage
  • Moderate
  • Severe

Cat scratch disease

  • Cat scratch disease[6]
  • Cat scratch disease in patients > 45 kg
  • Preferred regimen: Azithromycin 500 mg PO on day 1 AND 250 mg PO for additional 4 days
  • Cat scratch disease in patients < 45 kg
  • Preferred regimen: Azithromycin 10 mg/kg PO on day 1 AND 5 mg/kg PO for 4 more days

Cellulitis

  • Non purulent Cellulitis
  • Mild (typical cellulitis/erysipelas with no focus of purulence)
  • Moderate (typical cellulitis/erysipelas with systemic signs of infection)
  • Severe infection
  • Patients who have failed incision and drainage plus oral antibiotics
  • Those with systemic signs of infection such as temperature >38°C,
  • Tachycardia (heart rate >90 beats per minute),
  • Tachypnea (respiratory rate >24 breaths per minute) or
  • Abnormal white blood cell count (<12 000 or <400 cells/µL), or
  • Immunocompromised patients
  • Preferred regimen: Vancomycin AND piperacillin-tazobactam
  • Purulent Celluitits
  • Mild (typical cellulitis/erysipelas with no focus of purulence)
  • Preferred regimen: Incision and Drainage
  • Moderate (typical cellulitis/erysipelas with systemic signs of infection)
  • Severe infection: patients who have failed oral antibiotic regimen or those with systemic signs of infection (as defined above under purulent infection), or those who are immunocompromised, or those with clinical signs of deeper infection such as bullae, skin sloughing, hypotension, or evidence of organ dysfunction.

Ecthyma

  • Methicillin-Susceptible Staphylococcus Aureus
  • Preferred regimen (1): Dicloxacillin 250 mg PO qid for 7 days.
  • Preferred regimen (2): Cephalexin 250 mg PO qid for 7 days.
  • Methicillin-Resistant Staphylococcus Aureus
  • Preferred regimen (1): Doxycycline 100 mg PO bid
  • Preferred regimen (2): Clindamycin 600 mg every 8 h IV or 300–450 mg PO qid
  • Preferred regimen (3): Sulfamethoxazole-trimethoprim 25–40 mg/kg/d in 3 divided doses IV or 25–30 mg/kg/d in 3 divided doses PO

Erysipelas

  • 1. Adults
  • 2. Pediatrics
  • Preferred regimen (1): Penicillin 25 to 50 mg/kg/day PO tid or qid
  • Preferred regimen (2): Amoxicillin 25 to 50 mg/kg/day PO tid
  • Preferred regimen (3): Erythromycin 30 to 50 mg/kg/day PO bid to qid
  • Preferred regimen (4): Ceftriaxone 50 to 75 mg/kg/day IV q12-24h
  • Preferred regimen (5): Cefazolin 100 mg/kg/day IV q8h

Erysipeloid

  • Preferred regimen (1): Penicillin 500 mg qid for 7–10 days
  • Preferred regimen (2): Amoxicillin 500 mg tid for 7–10 days

Erythrasma

  • Localized infection
  • Preferred regimen : Clindamycin Topical bid or tid for 7-14 days
  • Widespread infection
  • Preferred regimen (2): Erythromycin 250 mg PO bid for 14 days

Fournier gangrene

  • Fournier gangrene[10]
  • If caused by streptococcus species or clostridia
  • Polymicrobial
  • MRSA (methicillin resistant staphylococcus aureus) suspected

Furuncle

  • Mild
  • Preferred regimen: Incision and Drainage
  • Moderate
  • Severe

Gas gangrene

  • 1. Empiric antimicrobial therapy
  • 2. Culture directed antimicrobial therapy
  • 2.1 Clostridium perfringens

Glanders

Mastitis

Necrotizing fasciitis

  • Necrotizing fasciitis[6]
  • 1. Mixed infections
  • 1.1 Adults
  • 1.2 Pediatrics
  • Preferred regimen (1): Piperacillin-tazobactam 60–75 mg/kg/dose of the Piperacillin component IV q6h AND Vancomycin 10–13 mg/kg/dose IV q8h
  • Note: Severe pencillin allergy, use clindamycin or metronidazole with an aminoglycoside or fluoroquinolone)
  • Preferred regimen (2): Meropenem 20 mg/kg/dose IV q8h
  • Preferred regimen (3): Ertapenem 15 mg/kg/dose IV q12h for children 3 months-12 years
  • Preferred regimen (4): Cefotaxime 50 mg/kg/dose IV q6h AND Metronidazole 7.5 mg/kg/dose IV q6h
  • Preferred regimen (5): Cefotaxime 50 mg/kg/dose IV q6h AND Clindamycin 10–13 mg/kg/dose IV q8h
  • 2. Streptococcus infection
  • 2.1 Adults
  • Preferred regimen: Penicillin 2–4 MU IV q4–6h AND Clindamycin 600–900 mg IV q8h
  • Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin
  • 2.2 Pediatric
  • Preferred regimen: Penicillin 0.06–0.1 MU/kg/dose IV q6h AND Clindamycin 10–13 mg/kg/dose IV q8h
  • Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin
  • 3. Staphylococcus aureus
  • 3.1 Adults
  • Preferred regimen (1): Nafcillin 1–2 g IV q4h
  • Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin
  • Preferred regimen (2): Oxacillin 1–2 g IV q4h
  • Preferred regimen (3): Cefazolin 1 g IV q8h
  • Preferred regimen (4): Vancomycin 30 mg/kg/day IV q12h
  • Preferred regimen (5): Clindamycin 600–900 mg IV q8h
  • Pediatrics
  • Preferred regimen (1): Nafcillin 50 mg/kg/dose IV q6h
  • Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin
  • Preferred regimen (2): Oxacillin 50 mg/kg/dose IV q6h
  • Preferred regimen (3): Cefazolin 33 mg/kg/dose IV q8h
  • Preferred regimen (4): Vancomycin 15 mg/kg/dose IV q6h
  • Preferred regimen (5): Clindamycin 10–13 mg/kg/dose IV q8h (bacteriostatic; potential cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA)
  • 4. Clostridium species
  • 4.1 Adults
  • 4.2 Pediatrics
  • 5. Aeromonas hydrophila
  • 5.1 Adults
  • 5.2 Pediatrics
  • Not recommended for children but may need to use in life-threatening situations
  • 6. Vibrio vulnificus
  • 6.1 Adults
  • 6.2 Pediatrics
  • Not recommended for children but may need to use in life-threatening situation

Pilonidal cyst

  • Pilonidal cyst[6]
  • Preferred regimen: After the pathogens isolated, a 5-10 day course of antibiotic is prescribed.

Pyomyositis

  • Preferred regimen (3): Cefazolin 2 g IV q8h (if MSSA)
  • Alternate regimen: Vancomycin 1 g IV q12h (if MRSA)

Seborrheic dermatitis

  • Seborrheic dermatitis[6]
  • 1. Antifungal agents
  • Preferred regimen (1): Ketoconazole 2% in shampoo, foam, gel, or cream
  • Scalp: Twice/week for clearance THEN once/week or every other week for maintenance
  • Other areas: From bid to twice/week for clearance THEN from twice/week to once every other week for maintenance
  • Preferred regimen (2): Bifonazole 1% in shampoo or cream
  • Scalp: 3 times/week for clearance
  • Other areas: qd for clearance
  • Preferred regimen (3): Ciclopirox olamine (also called ciclopirox) 1.0% or 1.5% in shampoo or cream
  • Scalp: Twice to 3 times/week for clearance THEN once/week or every 2 week for maintenance
  • Other areas: Twice daily for clearance THEN qd for maintenance
  • 2. Corticosteroids
  • Scalp: Twice weekly in a short- contact fashion (up to 10 min application, then washing)
  • Preferred regimen (5): Desonide 0.05% lotion bid on scalp and other areas
  • 3. Lithium salts

Skin and soft tissue infection in neutropenic fever

  • Treatment of skin and soft tissue infection in neutropenic fever[6]
  • 1. Initial episode
  • 2. Recurrent or persistent
  • Empiric treatment
  • 2.1 Antibacterial therapy
  • Preferred regimen (1): Vancomycin 30–60 mg/kg/day IV in 2–4 divided doses (Target serum trough concentrations of 15–20 µg/mL in severe infections)
  • Preferred regimen (2): Daptomycin 4–6 mg/kg/day IV (Covers VRE, strains nonsusceptible to vancomycin may be cross-resistant to daptomycin)
  • Preferred regimen (3): Linezolid 600 mg q12h IV (100% oral bioavailability; so oral dose same as IV dose. Covers VRE and MRSA)
  • Preferred regimen (4): Colistin 5 mg/kg IV loaing dose, THEN 2.5 mg/kg q12h IV (Nephrotoxic; does not cover gram-positives or anaerobes, Proteus, Serratia, Burkholderia)
  • 2.2 Antifungal therapy
  • Preferred regimen (1): Fluconazole 100–400 mg PO q24h OR Fluconazole 800 mg IV loading dose, THEN 400 mg qd (Candida krusei and Candida glabrata are resistant)
  • Preferred regimen (2): Voriconazole 400 mg PO bid in 2 doses, then 200 mg q12h OR Voriconazole 6 mg/kg IV q12h for 2 doses, THEN 4 mg/kg IV q12h (Accumulation of cyclodextrin vehicle with IV formulation with renal insufficiency)
  • Preferred regimen (3): Posaconazole 400 mg PO bid with meals (Covers Mucorales)
  • Preferred regimen (4): Lipid complex Amphotericin-B 5 mg/kg/day IV (Not active against fusaria)
  • Preferred regimen (5): Liposomal Amphotericin-B 3–5 mg/kg/day IV (Not active against fusaria)
  • Culture directed antimicrobial therapy
  • Candida
  • Aspergillus
  • Fusarium
  • Dissemianted HSV or VZV

Skin and soft tissue infection in cellular immunodeficiency

  • Skin and soft tissue infection in neutropenic fever[6]
  • Empiric treatment :
  • Antibiotics, antifungal, antivirals should be considered in life threatening situtations
  • Culture directed antimicrobial therapy
  • Bacteria
  • Non tuberculosis mycobacteria
  • Nocardia
  • Fungus
  • Aspergillus
  • Histoplasmosis
  • Cryptococcus
  • Candida
  • Virus
  • HSV
  • VZV

Surgical site infection

  • Surgical site infection treatment[6]
  • 1. Surgery of intestinal or genitourinary tract
  • 1.1 Single-drug regimens
  • 1.2 Combination regimens
  • 2. Surgery of trunk or extremity away from axilla or perineum
  • 3. Surgery of axilla or perineum

Tularemia

  • Tularemia treatment[6]

Ulcerated skin: Venous/Arterial Insufficiency; Pressure with Secondary Infection (Infected Decubiti)

  • Ulcerated skin: venous/arterial insufficiency; pressure with secondary infection (infected decubiti) treatment[14]
  • Preferred regimen (1): Imipenem 0.5 g IV q6h (OR Meropenem 1 g IV q24h OR Doripenem 500 mg IV q8h)
  • Preferred regimen (2): Ticarcillin-Clavulanate 3.1 g IV q8h
  • Preferred regimen (3): Piperacillin-Tazobactam 3.375 g IV q6h
  • Preferred regimen (4): Ertapenem 1 g IV q24h
  • Alternative regimen (1): Ciprofloxacin 500 mg PO bid OR Levofloxacin PO 500 mg qd AND Metronidazole 500 mg PO qid
  • Alternative regimen (2): Cefepime 2 g IV q12h OR Ceftazidime 2 g IV q8h AND Metronidazole 500 mg PO qid
  • Note (1): If gram positive cocci on gram stain add Vancomycin.
  • Note (2): If the ulcer is inflamed, treat with parenteral antibiotics with no topical treatment.
  • Note (3): If the ulcer is not clinically inflamed, consider debridement, removal of foreign body, reduce the pressure for weight bearing limbs and leg elevation.
  • Note (4): If not inflamed, healing improved on air bed, protein supplement, radiant heat and electric stimulation.
  • Note (5): Avoid chlorhexidine and povidone iodine as it may harm the granulation tissue.

Vibrio infection

  • Vibrio infection[6]
  • Vibrio vulnificus in adults
  • Preferred regimen: Doxycycline 100 mg IV q12h AND ceftriaxone 1 g IV qid OR cefotaxime 2 g IV tid
  • Note: Antibiotic treatment is not recommended for children but may need to use in life-threatening situation

Wound infection

  • 1. Mild to moderate
  • Preferred regimen (1): TMP-SMX-DS double strength 1-2 tabs PO bid
  • Preferred regimen (2): Clindamycin 300-450 mg PO tid
  • Alternative regimen (1): Minocycline 100 mg PO bid
  • Alternative regimen (2): Linezolid 600 mg PO bid
  • 2. Febrile with sepsis

Yaws

  • Preferred regimen (1): Phenoxymethylpenicillin 12.5 mg/kg q6h 7-10days (maximum dose, 300 mg q6h)
  • Preferred regimen (2): Tetracyclines 500 mg q6h 15 days or doxycycline 100 mg q12h (alternative agents for the treatment of yaws in nonpregnant adults)
  • Preferred regimen (3): Erythromycin 8–10 mg/kg 15 days q6h
  • Preferred regimen (4): Azithromycin 30 mg/kg single-dose (maximum dose 2 g)

References

  1. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  2. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  3. ↑ Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT; et al. (2014). "Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130687. PMC 3901462. PMID 24447897.
  4. ↑ Spach DH, Koehler JE (1998). "Bartonella-associated infections". Infect Dis Clin North Am. 12 (1): 137–55. PMID 9494835.
  5. ↑ 5.0 5.1 Mofenson LM, Brady MT, Danner SP, Dominguez KL, Hazra R, Handelsman E; et al. (2009). "Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-exposed and HIV-infected children: recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics". MMWR Recomm Rep. 58 (RR-11): 1–166. PMC 2821196. PMID 19730409.
  6. ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 6.12 6.13 6.14 6.15 6.16 Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America". Clin Infect Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.
  7. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  8. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  9. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  10. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  11. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  12. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  13. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  14. ↑ Greer N, Foman NA, MacDonald R, Dorrian J, Fitzgerald P, Rutks I; et al. (2013). "Advanced wound care therapies for nonhealing diabetic, venous, and arterial ulcers: a systematic review". Ann Intern Med. 159 (8): 532–42. doi:10.7326/0003-4819-159-8-201310150-00006. PMID 24126647. Review in: Evid Based Med. 2014 Jun;19(3):91
  15. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
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