Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue

Infections: 2014 Update by the Infectious Diseases Society of America

Dosage, Dosage,
Disease Entity Antibiotic Comment
Adults Childrena
250 mg qid
Dicloxacillin N/A N/A
po
25–50
250 mg qid mg/kg/d in 3–
Cephalexin N/A
po 4 divided
doses po
Some strains
40 mg/kg/d in of Staphylococcus
250 mg qid
Erythromycin 3–4 divided aureus and Streptococ
poc
doses po cus pyogenes may be
resistant.
20 mg/kg/d in
Impetigo 300–400
Clindamycin 3 divided N/A
(Staphylococcusand Streptococ mg qid po
doses po
cus)
25 mg/kg/d of
the
Amoxicillin- 875/125 mg amoxicillin
N/A
clavulanate bid po component in
2 divided
doses po
For patients with
Retapamulin Apply to Apply to
limited number of
ointment lesions bid lesions bid
lesions
For patients with
Mupirocin Apply to Apply to
limited number of
ointment lesions bid lesions bid
lesions
100–150 Parental drug of
Nafcillin or 1-2 g every
mg/kg/d in 4 choice; inactive
oxacillin 4 h IV
divided doses against MRSA
For penicillin-allergic
patients except those
with immediate
50 mg/kg/d in hypersensitivity
1 g every 8
Cefazolin 3 divided reactions. More
h IV
doses convenient than
MSSA SSTI
nafcillin with less
bone marrow
suppression
25–40 Bacteriostatic;
600 mg
mg/kg/d in 3 potential of cross-
every 8 h
divided doses resistance and
Clindamycin IV or
IV or emergence of
300–450
25–30 resistance in
mg qid po
mg/kg/d in 3 erythromycin-resistant
 Dosage, Dosage,
Disease Entity Antibiotic Comment
Adults Childrena
divided doses strains; inducible
po resistance in MRSA
Oral agent of choice
25–50
for methicillin-
500 mg qid mg/kg/d in 4
Dicloxacillin susceptible strains in
po divided doses
adults. Not used much
po
in pediatrics
For penicillin-allergic
patients except those
with immediate
25–50
hypersensitivity
500 mg qid mg/kg/d 4
Cephalexin reactions. The
po divided doses
availability of a
po
suspension and
requirement for less
frequent dosing
Not Bacteriostatic; limited
Doxycycline, 100 mg bid
recommended recent clinical
minocycline po
for age <8 yd experience
8–12 mg/kg
(based on
trimethoprim
1–2 double-
Trimethoprim- component)
strength Bactericidal; efficacy
sulfamethoxazo in either 4
tablets bid poorly documented
le divided doses
po
IV or 2
divided doses
po
For penicillin allergic
30 mg/kg/d 40 mg/kg/d in patients; parenteral
Vancomycin in 2 divided 4 divided drug of choice for
doses IV doses IV treatment of infections
caused by MRSA
10 mg/kg Bacteriostatic; limited
600 mg
every 12 h IV clinical experience; no
every 12 h
Linezolid or po for cross-resistance with
IV or 600
children <12 other antibiotic
mg bid po
y classes; expensive
MRSA SSTI
Bacteriostatic;
potential of cross-
25–40
resistance and
600 mg mg/kg/d in 3
emergence of
every 8 h divided doses
resistance in
Clindamycin IV or 300– IV or 30–40
erythromycin-resistant
450 mg qid mg/kg/d in 3
strains; inducible
po divided doses
resistance in MRSA.
po
Important option for
children
 Dosage, Dosage,
Disease Entity Antibiotic Comment
Adults Childrena
4 mg/kg
Bactericidal; possible
Daptomycin every 24 h N/A
myopathy
IV
600 mg bid
Ceftaroline N/A Bactericidal
IV
Not Bacteriostatic; limited
Doxycycline, 100 mg bid
recommended recent clinical
minocycline po
for age <8 yd experience
8–12 mg/kg/d
(based on
trimethoprim
1–2 double-
Trimethoprim- component) Bactericidal; limited
strength
sulfamethoxazo in either 4 published efficacy
tablets bid
le divided doses data
po
IV or 2
divided doses
po
antimicrobial
agents for
patients with
Pediatric
Non-purulent SSTI (cellulitis) Adult dosage severe N/A
dosage
penicillin
hypersensitivi
ty
Penicillin 2–4
Penicillin
million units
60–100 000
every 4–6 h IV
units/kg/do
Clindamycin Clindamycin,
se every 6 h
600–900 mg vancomycin,
10–13
every 8 h IV linezolid,
mg/kg dose
Nafcillin 1–2 g daptomycin,
every 8 h
every 4–6 h IV or telavancin.
Streptococcal skin infections IV N/A
Cefazolin 1 g Clindamycin
50
every 8 h IV resistance is
mg/kg/dose
Penicillin VK <1% but may
every 6 h
250–500 mg be increasing
33
every 6 h po in Asia
mg/kg/dose
Cephalexin 500
every 8 h
mg every 6 h
IV
po

Tabel 2. Antimicrobial Therapy for Staphylococcal and Streptococcal Skin and Soft Tissue
Infections