These empiric therapy recommendations are an excerpt from the full guidelines on Skin and Skin Structure Infection (SSTI) and Necrotizing Soft Tissue Infection (NSTI). Please refer to those guidelines for full details
Management of Recurrent SSTI is also discussed separately in those guidelines
| Diagnosis | Common Pathogens | Drug(s) of First Choice | Alternative Drug(s) | Comments | Expected Duration |
|---|---|---|---|---|---|
| Non-purulent SSTI (hospitalized) (Cellulitis/erysipelas) | Group A Strep | Cefazolin | Cephalosporin allergy or SJS/TEN or DRESS to Penicillins (see allergy guidelines): Most patients with penicillin allergies can safely receive Cefazolin | Cephalexin recommended for oral step down Consider changing to Vancomycin if not responding, as well as imaging for abscess, and considering alternative diagnoses | 5 days |
Non-purulent SSTI (outpatient) (Cellulitis/erysipelas) | Group A Strep | Cephalexin | Beta-lactam allergy: | 5 days | |
| Purulent SSTI (hospitalized) (Abscess/Pustule) | Staph aureus Group A Strep | Vancomycin | Vancomycin intolerance/allergy (rare): Linezolid | Drainage of abscess recommended if feasible Oral step down based on culture data, if no culture data available: Trimethoprim/Sulfamethoxazole or Clindamycin | 5 Days |
| Purulent SSTI (outpatient) (Abscess/Pustule) | Staph aureus Group A Strep | Trimethoprim/Sulfamethoxazole | Sulfa allergy: | Drainage of abscess recommended if feasible. Target culture data if available | 5 days |
Necrotizing Soft Tissue Infection (NSTI) See linked guidelines | Group A Strep Mixed infection Staph aureus Clostridium sp. | PLUS | Penicillin allergy: Linezolid PLUS Ceftriaxone PLUS Metronidazole Cephalosporin allergy or SJS/TEN or DRESS to Penicillins: PLUS Aztreonam PLUS Metronidazole | Surgical management is critical to control of infection. Consult appropriate surgical service and infectious diseases Linezolid used for anti-toxin effect in light of rising Group A Strep resistance to Clindamycin See full Necrotizing Soft Tissue Infection Guidelines for further details, including de-escalation of anti-toxin agent and antimicrobial step down based on culture data | 5 days after final debridement; minimum 7 days total (see guidelines) |
| Lower Extremity Ulcerative SSTI | See full SSTI Guidelines | ||||
See respective guidelines (linked above)