Skin and Soft Tissue Guideline

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. 

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Miller LG, Daum RS, Creech CB, et al. Clindamycin versus Trimethoprim–Sulfamethoxazole for Uncomplicated Skin Infections. N Engl J Med. 2015;372(12):1093-1103. doi:10.1056/NEJMoa1403789

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

Schuler CL, Courter JD, Conneely SE, et al. Decreasing Duration of Antibiotic Prescribing for Uncomplicated Skin and Soft Tissue Infections. PEDIATRICS. 2016;137(2):e20151223-e20151223. doi:10.1542/peds.2015-1223

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

Daum RS, Miller LG, Immergluck L, et al. A Placebo-Controlled Trial of Antibiotics for Smaller Skin Abscesses. N Engl J Med. 2017;376(26):2545-2555. doi:10.1056/NEJMoa1607033

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