Sandbox ID Skin and Soft Tissues

Acne vulgaris

• Acne vulgaris

• 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

• Preferred regimen: Erythromycin 3% Topical AND Benzoyl peroxide 5% Topical bid
• Alternative regimen: Clindamycin 1% gel Topical bid AND Benzoyl peroxide 5% Topical bid

• 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 (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

• 1. Facial erythema

• Preferred regimen: Brimonidine gel Topical bid, applied to the affected area

• 2. Papulopustular rosacea

• Preferred regimen (1): Azelaic acid gel Topical bid

• Preferred regimen (2): Metronidazole cream Topical qd

Anthrax, cutaneous

• 1. Cutaneous anthrax

• Preferred regimen (1): Penicillin V 500 mg PO qid for 7–10 days
• 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

• 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

• 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

• 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

• 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

• 1. Adults

• Preferred regimen (1): Amoxicillin 500 mg PO tid
• Preferred regimen (2): Doxycycline 100 mg PO bid
• Preferred regimen (3): Cefuroxime axetil 500 mg PO bid OR 30 mg/kg/day PO bid (maximum, 500 mg/dose)
• Preferred regimen (4): Ceftriaxone 2 g IV q24h
• Alternative regimen (1): Doxycycline 200 mg PO single dose
• Alternative regimen (2): Cefotaxime 2 g IV q8h
• Alternative regimen (3): Penicillin G 18–24 MU/day IV q4h

• 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

• 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

• Mild

• Preferred treatment: Incision and Drainage

• Moderate

• Empiric treatment: TMP-SMX OR Doxycycline
• Culture directed treatment

• 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

Cat scratch disease

• Cat scratch disease

• 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

• Cellulitis

• Non purulent Cellulitis

• Mild (typical cellulitis/erysipelas with no focus of purulence)

• Preferred regimen (1): Penicillin VK 500 mg PO bid
• Preferred regimen (2): Cephalosporin
• Preferred regimen (3): Dicloxacillin
• Preferred regimen (4): Clindamycin 600-900 mg IV q6-8h

• Moderate (typical cellulitis/erysipelas with systemic signs of infection)

• Preferred regimen (1): Penicillin VK 500 mg PO bid
• Preferred regimen (2): ceftriaxone 1-2 g q4-8h
• Preferred regimen (3): cefazolin
• 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
• Empiric regimen : Vancomycin OR daptomycin OR linezolid OR televancin OR ceftaroline
• MRSA : Vancomycin OR daptomycin OR linezolid OR televancin OR ceftaroline

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

• 1. Adults

• Preferred regimen (1): Penicillin 500 mg PO qid
• Preferred regimen (2): Amoxicillin 500 mg PO qid
• 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

• 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

• Erysipeloid

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

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

Erythrasma

• Erythrasma

• 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 (2): Erythromycin 250 mg PO bid for 14 days

Fournier gangrene

• Fournier gangrene

• 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

Furuncle

• Furuncle

• Mild

• Preferred regimen: Incision and Drainage

• Moderate

• Empiric treatment :TMP-SMX OR Doxycycline
• Culture directed treatment

• MSSA (methicilin susceptible staphylococcus aureus): TMP-SMX
• MRSA (methicilin resistant staphylococcus aureus): dicloxacillin OR cephalexin

• Severe

• Empiric treatment :Vancomycin OR daptomycin OR linezolid OR televancin OR ceftaroline
• Culture directed treatment

• MSSA (methicilin susceptible staphylococcus aureus): Nafcillin OR cefazolin OR clindamycin
• MRSA (methicilin resistant staphylococcus aureus): Vancomycin OR daptomycin OR linezolid OR televancin OR ceftaroline

Gas gangrene

• Gas gangrene

• 1. Empiric antimicrobial therapy

• Preferred regimen (1): Vancomycin 1 g IV q12h AND (Piperacillin-tazobactam 3.375 g q6h

• Preferred regimen (2): Vancomycin 1 g IV q12h AND Ampicillin-sulbactam 3 g IV q6h

• 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

• Preferred regimen: Ceftazidime OR Gentamicin OR Imipenem OR Doxycycline OR Ciprofloxacin is recommended based on in vitro susceptibility

Mastitis

• Mastitis

• Preferred regimen (1): Amoxicillin-clavulanate 875 mg PO bid
• Preferred regimen (2): Cephalexin 500 mg PO qid
• Preferred regimen (3): Ciprofloxacin 500 mg PO bid
• Preferred regimen (4): Clindamycin 300 mg PO qid
• Preferred regimen (5): Dicloxacillin 500 mg PO qid
• Preferred regimen (6): Trimethoprim-sulfamethoxazole 160 mg/800 mg PO bid

Necrotizing fasciitis

• Necrotizing fasciitis

• 1. Mixed infections

• 1.1 Adults

• Preferred regimen (1): Piperacillin-tazobactam 3.37 g IV q6–8h AND Vancomycin 30 mg/kg/day IV q12h
• Note: In case of severe pencillin allergy, use clindamycin or metronidazole with an aminoglycoside or fluoroquinolone
• Preferred regimen (2): Imipenem-cilastatin 1 g IV q6–8h
• Preferred regimen (3): Meropenem 1 g IV q8h
• Preferred regimen (4): Ertapenem 1 g IV q24h
• Preferred regimen (5): Cefotaxime 2 g IV q6h AND Metronidazole 500 mg IV q6h
• Preferred regimen (6): Cefotaxime 2 g IV q6h AND Clindamycin 600–900 mg IV q8h

• 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

• 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

• 6.2 Pediatrics

• Not recommended for children but may need to use in life-threatening situation

Pilonidal cyst

• Pilonidal cyst

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

Pyomyositis

• Pyomyositis

• 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

• 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

• 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 qd or bid
• Preferred regimen (3): Clobetasol 17- butyrate 0.05% in cream areas other than scalp qd or bid
• Preferred regimen (4): Clobetasol dipro- pionate 0.05% in shampoo

• 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

• Preferred regimen: Lithium succinate AND Zinc sulfate Ointment containing 8% Lithium succinate AND 0.05% Zinc sulfate
• Preferred regimen: Lithium gluconate 8% in gel bid on areas other than scalp

Skin and soft tissue infection in neutropenic fever

• Treatment of skin and soft tissue infection in neutropenic fever

• 1. Initial episode

• Empiric treatment : Vancomycin AND (Carbapenem OR Imipenem OR Meropenem OR Doripenem OR Piperacillin-Tazobactam)

• 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
• 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

• 1. Surgery of intestinal or genitourinary tract

• 1.1 Single-drug regimens

• Preferred regimen (1): Ticarcillin-clavulanate 3.1 g IV q6h
• Preferred regimen (2): Piperacillin-tazobactam 3.375 g IV q6h OR Piperacillin-tazobactam 4.5 g IV q8h
• 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)

• 2. Surgery of trunk or extremity away from axilla or perineum

• 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 treatment

• 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)

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

• Ulcerated skin: venous/arterial insufficiency; pressure with secondary infection (infected decubiti) treatment

• 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 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

• 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

• 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 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)