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

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: Penicillin 500 mg qid for 7–10 days OR Amoxicillin 500 mg tid for 7–10 days

Erythrasma

• Erythrasma

• Localized infection

• Preferred regimen : Topical clindamycin 2-3 times daily for 7-14 days

• Widespread infection

• Preferred regimen : clarithromycin 500mg PO bid OR erythromycin 250mg PO bid for 14 days

Fournier gangrene

• Fournier gangrene

• Streptococcus or clostridia : Penicillin G
• Polymicrobial : Doripenem OR imipenem OR meropenem
• MRSA suspected :vancomycin OR daptomycin

Furuncle

• Furuncle

• Mild  : 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

Gas gangrene

• Gas gangrene

• Empiric antimicrobial therapy

• Preferred regimen : vancomycin1gm IV q12h AND (piperacillin-tazobactam3.375 gm q6h OR ampicillin-sulbactam3 gm IV q6h OR carbapenem)

• Culture directed antimicrobial therapy

• Clostridium perfringens

• Preferred regimen  : penicillin G 24 million units/day divided q4-6h IV AND clindamycin 900 mg IV q8h
• Alternative regimen : erythromycin1 gm q6h IV OR ceftriaxone 2gm 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 (Augmentin), 875 mg twice daily
• Preferred regimen (2): Cephalexin (Keflex),500 mg four times daily
• Preferred regimen (3): Ciprofloxacin (Cipro),500 mg twice daily
• Preferred regimen (4): Clindamycin (Cleocin),300 mg four times daily
• Preferred regimen (5): Dicloxacillin (Dynapen, brand no longer available in the United States), 500 mg four times daily
• Preferred regimen (6): Trimethoprim/sulfamethoxazole (Bactrim, Septra),160 mg/800 mg twice daily

Necrotizing fasciitis

• Necrotizing fasciitis

• Mixed infections, adult

• 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)
• Preferred regimen (2): Imipenem-cilastatin 1 g every 6–8 h IV
• Preferred regimen (3): Meropenem 1 g every 8 h IV
• Preferred regimen (4): Ertapenem 1 g daily IV
• Preferred regimen (5): Cefotaxime2 g every 6 h IV AND (metronidazole500 mg every 6 h IV OR clindamycin600–900 mg every 8 h IV)

• Mixed infections, pediatric

• 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 (2): Meropenem 20 mg/kg/dose every 8 h IV
• Preferred regimen (3): Ertapenem 15 mg/kg/dose every 12 h IV for children 3 mo-12 y
• Preferred regimen (4): Cefotaxime50 mg/kg/dose every 6 h IVAND (metronidazole7.5 mg/kg/dose every 6 h IVOR clindamycin10–13 mg/kg/dose every 8 h IV)

• Streptococcus, adult

• 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)

• Streptococcus, pediatric

• Preferred regimen: Penicillin60 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)

• Staphylococcus aureus, adult

• Preferred regimen (1): Nafcillin 1–2 g every 4 h IV (Severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)
• Preferred regimen (2): Oxacillin 1–2 g every 4 h IV
• Preferred regimen (3): Cefazolin 1 g every 8 h IV
• Preferred regimen (4): Vancomycin 30 mg/kg/d in 2 divided doses IV
• Preferred regimen (5): Clindamycin 600–900 mg every 8 h IV
• Staphylococcus aureus, pediatric

• Preferred regimen (1): Nafcillin 50 mg/kg/dose every 6 h IV (Severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)
• Preferred regimen (2): Oxacillin 50 mg/kg/dose every 6 h IV
• Preferred regimen (3): Cefazolin 33 mg/kg/dose every 8 h IV
• Preferred regimen (4): Vancomycin 15 mg/kg/dose every 6 h IV
• 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)

• Clostridium species, adult

• Preferred regimen: Clindamycin 600–900 mg every 8 h IV AND penicillin 2–4 million units every 4–6 h IV

• Clostridium species, pediatric

• 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

• Aeromonas hydrophila, adult
• 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)

• Aeromonas hydrophila, pediatric

(Not recommended for children but may need to use in life-threatening situations)

• Vibrio vulnificus, adult

• Preferred regimen: Doxycycline 100 mg every 12 h IV AND ceftriaxone 1 g qid IV OR cefotaxime 2 g tid IV

• Vibrio vulnificus, pediatric

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.

Pyomyositis

• Pyomyositis

• Preferred regimen : nafcillin OR oxacillin 2 gm IV q4h OR cefazolin 2gm IV q8h (If MSSA)
• Alternate regimen : vancomycin 1gm IV q 12h (If MRSA)

Seborrheic dermatitis

• Seborrheic dermatitis

• Antifungal agents

• 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
• Preferred regimen (2): Bifonazole 1% in shampoo or cream Scalp: 3 times/wk for clearance; other areas: once daily for clearance
• Preferred regimen (3): 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

• Corticosteroids

• Preferred regimen (1): Hydrocortisone 1% in cream Areas other than scalp: once or twice daily
• Preferred regimen (2): Betamethasone dipropionate 0.05% in lotion Scalp and other areas: once or twice daily
• Preferred regimen (3): Clobetasol 17- butyrate 0.05% in cream Areas other than scalp: once or twice daily
• 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% in lotion Scalp and other areas of skin: twice daily

• Lithium salts

• Preferred regimen: Lithium succinate AND zinc sulfate Ointment containing 8% lithium succinate plus 0.05% zinc sulfate
• Preferred regimen: Lithium gluconate 8% in gel Areas other than scalp: twice daily

Skin and soft tissue infection in neutropenic fever

• Skin and soft tissue infection in neutropenic fever

• Initial episode

• Empiric treatment : vancomycin AND (Carbapenem OR imipenem OR meropenem OR doripenem OR piperacillin-tazobactam)
• Recurrent or persistent
• Empiric treatment :

• Antibacterial

• 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)
• Preferred treatment : Daptomycin 4–6 mg/kg/d IV (Covers VRE, strains nonsusceptible to vancomycin may be cross-resistant to daptomycin)
• Preferred treatment : Linezolid 600 mg every 12 h 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)

• Antifungal

• 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 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 treatment : Posaconazole 400 mg bid PO with meals (Covers Mucorales)
• Preferred treatment : Lipid complex amphotericin B 5 mg/kg/d IV (Not active against fusaria)
• Preferred treatment : Liposomal amphotericin B 3–5 mg/kg/d 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

• 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

• Preferred regimen (1): Oxacillin or nafcillin 2 g every 6 h IV
• Preferred regimen (2): Cefazolin 0.5–1 g every 8 h IV
• Preferred regimen (3): Cephalexin 500 mg every 6 h po
• Preferred regimen (4): SMX-TMP 160–800 mg po every 6 h
• Preferred regimen (5): Vancomycin 15 mg/kg every 12 h IV

• Surgery of 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)

Tularemia

• Tularemia

• Preferred regimen (1): Streptomycin 15 mg/kg every 12 hours IM OR Gentamicin 1.5 mg/kg every 8 hours IV
• Preferred regimen (2): Tetracycline 500 mg qid OR doxycycline 100 mg bid PO (for mild cases)

Vascular insufficieny ulcer

• Vascular insufficieny ulcer

• 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

Vibrio infection

• Vibrio infection

• Vibrio vulnificus, adult

• Preferred regimen: Doxycycline 100 mg every 12 h IV AND ceftriaxone 1 g qid IV OR cefotaxime 2 g tid IV

• Vibrio vulnificus, pediatric

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

Wound infection

• Wound infection

• Mild to moderate

• Preferred regimen : TMP-SMX double strength 1-2 tabs PO bid OR clindamycin 300-450 mg PO tid
• Alternate regimen : Minocycline 100mg PO bid OR linezolid 600mg PO bid

• Febrile with sepsis

• Preferred regimen : Ticarcillin-clavulanate 3.1 gm IV q4-6hr OR piperacillin-tazobactam 3.375 gm q 6hr OR doripenem500 mg IV q 8hr OR imipenem OR meropenem OR ertapenem 1gm IV q24 hr) AND vancomycin 1gm IV q12h
• 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)

Yaws

• Yaws

• Preferred regimen (1): Phenoxymethylpenicillin 7–10 d; 12.5 mg/kg q6h (maximum dose, 300 mg q6h)
• 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 (3): Erythromycin 15 d; 8–10 mg/kg q6h
• Preferred regimen (4): Azithromycin Single-dose; 30 mg/kg (maximum dose 2 g)