Sandbox ID Skin and Soft Tissues

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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]
  • Preferred oral regimens adults
  • Preferred regimen (1): Amoxicillin 500 mg 3 times per day
  • Preferred regimen (2): Doxycycline 100 mg twice per day
  • Preferred regimen (3): Cefuroxime axetil 500 mg twice per day 30 mg/kg per day in 2 divided doses (maximum, 500 mg per dose)
  • Alternative oral regimens adults
  • Preferred regimen (1): Doxycycline, 200 mg in a single dose
  • Parenteral regimen adults
  • Preferred regimen (1): Ceftriaxone 2 g intravenously once per day
  • Alternative parenteral regimens adults
  • Preferred regimen (1): Cefotaxime 2 g intravenously every 8 hd d
  • Preferred regimen (2): Penicillin G 18–24 million U per day intravenously, divided every 4 h
  • Preferred oral regimens pediatrics
  • Preferred regimen (1): Amoxicillin 50 mg/kg per day in 3 divided doses (maximum, 500 mg per 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)
  • Preferred regimen (3): Cefuroxime axetil 30 mg/kg per day in 2 divided doses (maximum, 500 mg per dose)
  • Alternative oral regimens pediatrics
  • Preferred regimen (1): Doxycycline, (4 mg/kg in children <8 years of age)
  • Preferred parenteral regimen pediatrics
  • Preferred regimen (1): Ceftriaxone 50–75 mg/kg intravenously per day in a single dose (maximum, 2 g)
  • 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[6]

Carbuncle

  • Mild  : Incision and Drainage
  • Moderate
  • Severe

Cat scratch disease

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

Cellulitis

  • Non purulent :
  • Mild : Typical cellulitis/erysipelas with no focus of purulence
  • Moderate : Typical cellulitis/erysipelas with systemic signs of infection
  • 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
  • Purulent :
  • Mild : Typical cellulitis/erysipelas with no focus of purulence
  • Preferred treatment : Incision and Drainage
  • Moderate : Typical cellulitis/erysipelas with systemic signs of infection.
  • 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.

Ecthyma

Erysipelas

  • Erysipelas (Adults)
  • Oral therapy
  • Preferred regimen (1): Penicillin 500 mg orally every six hours
  • Preferred regimen (2): Amoxicillin 500 mg orally every eight hours
  • Preferred regimen (3): Erythromycin 250 mg orally every six hours
  • Parenteral therapy
  • Preferred regimen (1): Ceftriaxone 1g intravenously every 24 hours
  • Preferred regimen (2): Cefazolin 1 to 2 g intravenously every eight hours
  • Erysipelas (pediatrics)
  • Oral therapy
  • Preferred regimen (1): Penicillin 25 to 50 mg/kg per day orally in three or four doses
  • 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

Erythrasma

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

Fournier gangrene

  • Fournier gangrene[10]

Furuncle

  • Mild  : Incision and Drainage
  • Moderate
  • Severe

Gas gangrene

  • Empiric antimicrobial therapy
  • Culture directed antimicrobial therapy
  • Clostridium perfringens

Glanders

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[6]
  • Mixed infections, adult
  • Mixed infections, pediatric
  • Streptococcus, adult
  • Streptococcus, pediatric
  • Staphylococcus aureus, adult
  • 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, pediatric

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

  • Vibrio vulnificus, adult
  • Vibrio vulnificus, pediatric

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

Pilonidal cyst

  • Pilonidal cyst[6]
  • Preferred regimen : A 5-10 day course of antibiotic active against pathogens isolated.

Pyomyositis

Seborrheic dermatitis

  • Seborrheic dermatitis[6]
  • 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

Skin and soft tissue infection in neutropenic fever

  • Skin and soft tissue infection in neutropenic fever[6]
  • Initial episode
  • 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[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[6]
  • Surgery of intestinal or genitourinary tract
  • Single-drug regimens
  • Combination regimens
  • 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

Tularemia

Vascular insufficieny ulcer

  • Vascular insufficieny ulcer[14]

Vibrio infection

  • Vibrio infection[6]
  • Vibrio vulnificus, adult
  • Vibrio vulnificus, pediatric

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

Wound infection

  • Mild to moderate
  • Febrile with sepsis

Yaws


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. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  15. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
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