VI. SKIN AND SOFT TISSUE INFECTIONS (SSTI)
(Use gram-stain of drainage to guide therapy)
• Cellulitis: Penicillin G 3 million units q 4-6h plus Cleocin 600mg q 8h (for Strep); OR, Nafcillin 2gm q 4-6h (for Staph)
• Wound Infection or Abscess: Nafcillin 2gm q 4-6h, OR Ancef 1gm q 8h, OR Cleocin 600mg q 8h.
• Diabetic or Ischemic Foot Infection (AFTER deep tissue, ulcer curettage, or bone biopsy culture): OPTION 1- Cipro 750mg po q 12h, PLUS Cleocin 600mg q8h.
OPTION 2- Ceftriaxone 1gm q 24h, PLUS Flagyl 500mg q 12h.
• Possible MRSA: Add Vancomycin 1-1.5gm q 12-24h (trough 10-15ug/ml) to each of above if "Health Care-Associated." D/C Vancomycin if cultures negative for MRSA/MRSE at 48hr.
• Streamlining: change to narrower-spectrum agent(s) based on microbiology results.