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]
  • 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

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 moths-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/wk for clearance, then once/wk or every other wk for maintenance; other areas from bid 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
  • 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% in lotion Scalp and other areas of skin: twice daily
  • 3. 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 in adults
  • Preferred regimen: Doxycycline 100 mg IV q12hAND 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. ↑ 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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