Optimal treatment is defined as ≤5 days of cephalexin for non-purulent SSTIs and ≤7 days of clindamycin or trimethoprim/sulfamethoxazole for purulent SSTIs. For purulent SSTI, optimal antibiotic choice plus duration increased from a baseline median of 28.4% to 62.4% (optimal choice was quite good even at the baseline of 89.3% to 92%; optimal duration increased from 31.9% to 67.7%). For non-purulent SSTI, optimal antibiotic choice plus duration increased from a median of 1.8% to 43% (optimal antibiotic choice increased from 27.6% to 68.8%; optimal duration increased from 4% to 43%). During the time period of this change, return visits requiring escalation in care remained stable (less the 2%) suggesting that there were not any known harmful effects the population we treat during this time period. 

We still have progress to make as a group in treating SSTI. Please see included references for your review if you are interested. 

CLaim CME for this article click Here but please read the Submersion Injury Guideline Article FIRST!

References

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Stevens DL, Bisno AL, Chambers HF, et al. 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. 2014;59(2):e10-e52. doi:10.1093/cid/ciu296

Moran GJ, Krishnadasan A, Mower WR, et al. Effect of Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis: A Randomized Clinical Trial. JAMA. 2017;317(20):2088. doi:10.1001/jama.2017.5653

Shuman EK, Malani PN. Empirical MRSA Coverage for Nonpurulent Cellulitis: Swinging the Pendulum Away From Routine Use. JAMA. 2017;317(20):2070. doi:10.1001/jama.2017.5654

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Holmes L, Ma C, Qiao H, et al. Trimethoprim-Sulfamethoxazole Therapy Reduces Failure and Recurrence in Methicillin-Resistant Staphylococcus aureus Skin Abscesses after Surgical Drainage. J Pediatr. 2016;169:128-134.e1. doi:10.1016/j.jpeds.2015.10.0

Talan DA, Mower WR, Krishnadasan A, et al. Trimethoprim–Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess. N Engl J Med. 2016;374(9):823-832. doi:10.1056/NEJMoa1507476

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