IDSA GUIDELINES Bundle (free trial)

Treatment Table 7. Suggested Empirical Antibiotic Regimens Based on Clinical Severity for DFI* (cont'd) Infection Severity Moderate (may be treated with oral or initial parenteral agent[s]) or Severe (usually treated with parenteral agent[s]) Probable Pathogen(s) MSSA; Streptococcus spp.; Enterobacteriaceae; obligate anaerobes Antibiotic Agent (Brand) Tigecyclinea (Tygacil® ) Comments Active against MRSA. Spectrum may be excessively broad. High rates of nausea and vomiting and increased mortality warning. Non- equivalent to ertapenem + vancomycin in 1 randomized clinical trial Levofloxacina (Levaquin® , generic) with generic) or ciprofloxacina (Cipro® clindamycina (Cleocin® ) Imipenem/cilastatina (Primaxin® MRSA Linezolida (Zyvox® ) Daptomycina (Cubicin® ) Vancomycina (generic) Pseudomonas aeruginosa MRSA, Enterobacteriaceae, Pseudomonas and obligate anaerobes Piperacillin/tazobactama (Zosyn® ) Vancomycinb plus one of the following: ceftazidime (Fortaz® generic), cefepime (generic), piperacillin/ tazobactama (generic) , aztreonama (Azactam® a carbapenema (Zosyn® ), ) or ) , Limited evidence supporting clindamycin for severe S. aureus infections; PO & IV formulations for both drugs Very broad-spectrum (but not against MRSA); use only when this is required. Consider when ESBL-producing pathogens suspected Expensive; increased risk of toxicities when used more than 2 weeks Once daily dosing. Requires serial monitoring of CPK Vancomycin MICs for MRSA are gradually increasing tid/qid dosing. Useful for broad-spectrum coverage. P. aeruginosa is an uncommon pathogen in DFIs except in special circumstances Very broad-spectrum coverage; usually only used for empiric therapy of severe infection. Consider addition of obligate anaerobe coverage if ceftazidime, cefepime, or aztreonam selected *Agents approved for treating skin and skin-structure infections based on studies that excluded patients with DFIs (eg, ceftaroline, telavancin) are not included. Agents in boldface type are those that have been most commonly used as comparators in clinical trials. Narrow spectrum agents (eg, vancomycin, linezolid, daptomycin) should be combined with other agents (eg, a fluoroquinolone) if a polymicrobial infection (especially moderate or severe) is suspected. Use an agent active against MRSA for patients who have a severe infection, evidence of infection or colonization with this organism elsewhere, or epidemiological risk factors for MRSA infection. Select definitive regimens after considering the results of culture and susceptibility tests from wound specimens, as well as the clinical response to the empirical regimen. Similar agents of the same drug class can probably be substituted for suggested agents. Some of these regimens do not have US Food and Drug Administration (FDA) approval for complicated skin and skin structure infections. The only agents currently specifically FDA- approved for DFIs are shown in green. a Agents shown effective in clinical trials including patients with DFIs. b Daptomycin or linezolid may be substituted for vancomycin. 10

• Cover