Treatment
2
Figure 1. Management of SSTI Infections
NONPURULENT
Necrotizing Infection/
Cellulitis/Erysipelas
• Emergent Surgical
Inspection/Debridement
▶ Rule out necrotizing
process
• Empiric Rx
▶ Vancomycin PLUS
Piperacillin/Tazobactam
PURULENT
Furuncle/Carbuncle/Abscess
Intravenous Rx
▶ Penicillin or
▶ Ceftriaxone or
▶ Cefazolin or
▶ Clindamycin
Oral Rx
▶ Penicillin VK or
▶ Cephalosporin or
▶ Dicloxacillin or
▶ Clindamycin
SEVERE MODERATE MILD
Defined Rx
(Necrotizing Infections)
Monomicrobial
a
• Streptococcus pyogenes
▶ Penicillin PLUS
Clindamycin
• Clostridial sp.
▶ Penicillin PLUS
Clindamycin
• Vibrio vulnificus
▶ Doxycycline PLUS
Ceftazidime
Aeromonas hydrophilia
▶ Doxycycline PLUS
Ciprofloxacin
Polymicrobial
a
▶ Vancomycin PLUS
Piperacillin/
Tazobactam
C & S
SEVERE MILD MODERATE
I & D
C & S
I & D
C & S
I & D
Empiric Rx
b
▶ Vancomycin or
▶ Daptomycin or
▶ Linezolid or
▶ Telavancin or
▶ Ceftaroline
Empiric Rx
▶ SMX/TMP or
▶ Doxycycline
Defined Rx
MRSA
• See Empiric
MSSA
• Nafcillin or
• Cefazolin or
• Clindamycin
Defined Rx
MRSA
▶ SMX/TMP
MSSA
• Dicloxacillin or
• Cephalexin
a
Tedizolid and dalbavancin (approved after publication of the 2014 guideline) are also effective
treatments of SSTI including those caused by MRSA.
b
Since daptomycin and telavancin are not approved for use in children, vancomycin is
recommended. Clindamycin may be used if clindamycin resistance is <10%-15% at the institution.
