University of Pennsylvania Medical Center Guidelines for Antibiotic Use

SKIN AND SOFT TISSUE INFECTIONS

Clinical Setting

Empiric Treatment

Likely Pathogens

Definitive Treatment

Dosage Regimen

Duration

Cellulitis

Extremities Normal Host

cefazolin1

S. aureus

group A streptococcus

same as empiric

500mg IV q 8 hour

7-10 days2

Diabetic Host (including diabetic foot)

TMP/SMX + metronidazole3,4

polymicrobial

same as empiric

TMP/SMX 8-10mg/kg/day TMP IV/PO in 3-4 divided doses

metronidazole 500mg IV/PO q 12 h

14 days2

Decubitus Ulcer5

cefazolin1

polymicrobial

same as empiric

cefazolin 500mg IV q 8 hour

7-10 days2

Wound Infection6 Trauma

(soft tissue wound, no bowel or bone involvement)





cefazolin1 + metronidazole3

polymicrobial

(consider Pseudomonas spp., Aeromonas spp. if trauma associated with water)

base therapy upon culture & sensitivity results

cefazolin 500mg IV q 8 hour

metronidazole 500mg IV/PO q 12 h

7 days

 

1If beta-lactam allergy use clindamycin or trimethoprim sulfamethoxazole; if MRSA-use vancomycin

2Can switch to oral therapy once clinical improvement occurs

3Not for aggressive anaerobic cellulitis

4Metronidazole: use if foul odor present

5Adequate wound debridement required; antibiotics only necessary for surrounding cellulitis

6Adequate wound debridement required

SKIN AND SOFT TISSUE INFECTIONS

Clinical Setting

Empiric Treatment

Likely Pathogens

Definitive Treatment

Dosage Regimen

Duration

Wound1 Post-operative- GI/GU

ampicillin/ sulbactam2

S. aureus

nafcillin3 or

cefazolin3

2gm IV q 4-6 hour

500mg IV q 8 hour

10 days1

Streptococcus spp.

ampicillin

1gm IV q 6 hour

Enterococcus spp.4

ampicillin +

gentamicin

2gm IV q 6 hour

peak conc. of 3-4 mcg/ml

Enterobacteriaceae

TMP/SMX

8-10mg/kg/day TMP IV in 3-4 divided doses

P. aeruginosa

piperacillin +

gentamicin

4gm IV q 6 hour

see this link

anaerobes

metronidazole (may need to add to above regimen)

500mg IV q 12 hour

Post-operative- sternal5

vancomycin + gentamicin

S. aureus

nafcillin3 or

cefazolin3

2gm IV q 4-6 hour

500mg IV q 8 hour

1-6 weeks depending upon clinical setting

coagulase negative staphylococcus

vancomycin

see this link

Streptococcus spp.

ampicillin

1gm IV q 6 hour

Enterobacteriaceae

TMP/SMX

TMP/SMX 8-10mg/kg/day TMP IV/PO in 3-4 divided doses

Bites

Animal/Human1,6 no bone or joint involvement

amoxicillin/clavulanic acid7

depends on the animal

same as empiric

500mg PO q 8 hour

7-10 days

bone and joint involvement

ampicillin/sulbactam7

depends on the animal

change empiric therapy to amoxicillin/clavulanic acid after adequate debridement and microorganism identification

ampicillin/sulbactam: 1.5 gm IV q 6 hour

Depends on the extent of disease

1Adequate wound debridement required

2Ampicillin/sulbactam dosage Regimen: 1.5 gm IV q 6 hour

3If beta-lactam allergy-use clindamycin or trimethoprim/sulfamethoxazole; if MRSA-vancomycin

4Review susceptibilities-30% of isolates multidrug resistant

5Rule-out osteomyelitis

6Patient should receive tetanus booster if series not up to date

7Penicillin allergy: human bite-erythromycin 500mg IV/PO q 6hr; animal bite-doxycycline 100mg IV/PO q 12hr

updated 9/28/04 by Lori LaRosa

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