Common Culprit: S. aureus
Outpatient Treatment (after drainage, if applicable):
Located in the face, hand, or perineum or from communities in which ≥10 to 15 percent of S. aureus isolates are MRSA
Clindamycin 30 to 40 mg/kg per day orally in 3 or 4 doses (maximum daily dose 1.8 g) for 5 days
Doxycycline 2 to 4 mg/kg per day orally in 1 or 2 doses (maximum daily dose 200 mg) for 5 days
Trimethoprim-sulfamethoxazole 8 to 12 mg/kg per day orally of TMP, 40 to 60 mg/kg per day of SMX (maximum daily dose 320 mg of TMP, 1.6 g of SMX) for 5 days
Low prevalence of MRSA and abscess not on face, hand, or perineum
Cephalexin 25 to 100 mg/kg per day orally in 3 or 4 doses (maximum daily dose 2 g) for 5 days
Cefadroxil 30 mg/kg per day orally in 2 divided doses (maximum daily dose 2 g) for 5 days
Cefuroxime 30 mg/kg per day orally in 2 doses (maximum daily dose 1 g) for 5 days
Clindamycin 30 to 40 mg/kg per day orally in 3 or 4 doses (maximum daily dose 1.8 g) for 5 days
2nd-line
Trimethoprim/Sulfamethoxazole 8 to 12 mg/kg per day orally of TMP, 40 to 60 mg/kg per day of SMX (maximum daily dose 320 mg of TMP, 1.6 g of SMX) for 5 days
2nd-line
Doxycycline 2 to 4 mg/kg per day orally in 1 or 2 doses (maximum daily dose 200 mg) for 5 days
2nd-line
Common Culprit: Cutibacterium acnes
Treatment:
Topical Clindamycin 1% gel, lotion, pledget, solution, foam once or twice daily
Mild acne
Use in conjunction with Benzoyl peroxide
Doxycycline 100mg twice daily for 3-4 months
More moderate to severe
Common Culprits: Trichophyton rubrum, T. mentagrophytes/interdigitale complex, and Epidermophyton floccosum
Treatment:
Clotrimazole 1% twice a day for 4 weeks
Terbinafine 1% once or twice a day for 1-4 weeks
NOT NYSTATIN
Common Culprits: Staphylococcus aureus (MSSA and MRSA), Group B Streptococcus (Streptococcus agalactiae), Gram-negative bacilli, Neisseria gonorrhoeae, Kingella kingae, Group A Streptococcus (Streptococcus pyogenes), Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), N. gonorrhoeae
Treatment:
Either Cefazolin, Nafcillin, Oxacillin, Clindamycin or vancomycin AND additional coverage as clinically indicated
Common Culprit: Pasteurella multocida, Capnocytophaga, Staphylococcus aureus, group A Streptococcus
Treatment of animal or human bite:
Amoxicillin-clavulanate 7:1 formulation 25 to 45 mg amoxicillin/kg/day in divided doses every 12 hours (max 875/125 a dose); prophylaxis: 3 to 5 days, established infection: 5 to 14 days.
Combination therapy with agent with activity against Pasteurella multocida and Capnocytophaga PLUS a second agent to cover anaerobes
Special Considerations:
Mice and rat bites may necessitate penicillin or ceftriaxone to cover rat bite fever, which is caused by Spirillum minus, Streptobacillus moniliformis, and Streptobacillus notomytis
Rabbit bites may need a fluroquinolone or doxycycline added to the patient’s antibiotic regimen to cover tularemia (caused by Francisella tularensis)
Common Culprit: Streptococci groups A, B, C, G, and F, S. aureus (less common)
Treatment (all treatment courses are 5 days):
Risk factors for MRSA
Clindamycin 30 to 40 mg/kg per day orally in 3 or 4 doses (maximum daily dose 1.8 g)
Preferred
Amoxicillin 40 to 50 mg/kg per day orally in 3 doses (maximum daily dose 1.5 g) plus Trimethoprim/Sulfamethoxazole 8 to 12 mg/kg per day orally of TMP, 40 to 60 mg/kg per day of SMX (maximum daily dose 320 mg of TMP, 1.6 g of SMX)
Cephalexin 25 to 100 mg/kg per day orally in 3 or 4 doses (maximum daily dose 2 g) plus Trimethoprim/Sulfamethoxazole 8 to 12 mg/kg per day orally of TMP, 40 to 60 mg/kg per day of SMX (maximum daily dose 320 mg of TMP, 1.6 g of SMX)
Amoxicillin 40 to 50 mg/kg per day orally in 3 doses (maximum daily dose 1.5 g) plus doxycycline 2 to 4 mg/kg per day orally in 1 or 2 doses (maximum daily dose 200 mg)
Cephalexin 25 to 100 mg/kg per day orally in 3 or 4 doses (maximum daily dose 2 g) plus doxycycline 2 to 4 mg/kg per day orally in 1 or 2 doses (maximum daily dose 200 mg)
No risk factors for MRSA
Cephalexin 25 to 100 mg/kg per day orally in 3 or 4 doses (maximum daily dose 2 g)
Preferred
Cefadroxil 30 mg/kg per day orally in 2 divided doses (maximum daily dose 2 g)
Cefuroxime 30 mg/kg per day orally in 2 doses (maximum daily dose 1 g)
Erysipelas
Amoxicillin 40 to 50 mg/kg per day orally in 3 doses (maximum daily dose 1.5 g)
Penicillin V 25 to 75 mg/kg per day orally in 3 or 4 doses (maximum daily dose 2 g)
Clindamycin 30 to 40 mg/kg per day orally in 3 or 4 doses (maximum daily dose 1.8 g)
2nd-line, PCN allergy
Special Considerations: In pilonidal disease with cellulitis consider Cephalexin 5 to 100 mg/kg/day divided every 6 to 8 hours (maximum dose 500 mg/dose) PLUS metronidazole
Common Culprits: Staphylococcus aureus, Streptococcus pyogenes, Candida albicans
Treatment of Secondary Bacterial Infection:
Topical mupirocin applied twice a day for five to seven days
If the infection is localized and mild
Special Considerations: Assess for Candida superinfection
Common Culprit: S. aureus
Treatment:
Limited Involvement:
Mupirocin topically three times daily for 5 days
Limited involvement
Retapamulin topically twice daily for 5 days
Limited involvement
Extensive involvement, 7 day course:
Cephalexin 25 to 50 mg/kg per day in 3 to 4 divided doses (max dose 250 to 500 mg)
Dicloxacillin 25 to 50 mg/kg per day in 4 divided doses (max dose 250 to 500 mg)
Erythromycin (base) 40 mg/kg per day in 3 to 4 divided doses (max 250 mg 4 times per day)
PCN and cephalosporin hypersensitivity
Clarithromycin 15 mg/kg per day in 2 divided doses (max 250 mg twice per day)
PCN and cephalosporin hypersensitivity
Common Culprits: T. rubrum. Other frequent causes include E. floccosum, T. mentagrophytes/interdigitale complex, and T. indotineae
Treatment:
Clotrimazole 1% once or twice a day for 1-3 weeks
Terbinafine 1% once or twice a day for 1-3 weeks
Extensive disease or if failing topical tx:
Terbinafine 10 to <20 kg: Oral: 62.5 mg once daily, 20 to 40 kg: Oral: 125 mg once daily, >40 kg: Oral: 250 mg once daily for 1-2 weeks
Common Culprit: Borreliaceae
Treatment:
Doxycycline 4.4 mg/kg/day orally divided twice daily (maximum 100 mg per dose) for 10 days
Amoxicillin 50 mg/kg/day orally divided 3 times daily (maximum 500 mg per dose) for 14 days
Cefuroxime axetil 30 mg/kg/day orally divided twice daily (maximum 500 mg per dose) for 14 days
Common Culprits: Staphylococcus aureus (most common), Enterococcus, Streptococcus pyogenes (group A Streptococcus), anaerobic streptococci, Pseudomonas, Streptococcus agalactiae (group B Streptococcus), and Bacteroides species
Treatment:
Cephalexin 25 to 50 mg/kg per day orally in three or four doses (max2 g/day) for 7-10 days
Clindamycin 30 to 40 mg/kg per day orally in three or four doses (max 1.8 g/day) for 7-10 days
PCN allergy
Common Culprit: Staphylococcus aureus
Treatment:
Oxacillin IV 150 to 200 mg/kg/day divided every 4 to 6 hours; maximum daily dose: 12 g/day for 3-4 weeks
Cefazolin IV 100 to 150 mg/kg/day divided every 6 to 8 hours; usual adult dose: 2,000 mg/dose; maximum daily dose: 12 g/day for 21-28 days
Clindamycin IV or oral 30 to 40 mg/kg/day divided every 6 to 8 hours; maximum dose: IV: 900 mg/dose; Oral: 600 mg/dose for ≥3 to 4 weeks
The term "tinea corporis" refers to epidermal dermatophyte infections in sites other than the feet, groin, face, or hand.
Common Culprits: T. rubrum is the most common cause of tinea corporis. Other notable causes include Trichophyton tonsurans, Microsporum canis, T. mentagrophytes/interdigitale complex, T. indotineae, Microsporum gypseum, Trichophyton violaceum, and Microsporum audouinii
Treatment:
Clotrimazole 1% once or twice a day for 1-3 weeks
Terbinafine 1% once or twice a day for 1-3 weeks
Extensive disease or if failing topical tx:
Terbinafine 10 to <20 kg: Oral: 62.5 mg once daily, 20 to 40 kg: Oral: 125 mg once daily, >40 kg: Oral: 250 mg once daily for 1-2 weeks
Common Culprit: Rickettsia rickettsii
Treatment:
Doxycycline 2.2 mg/kg/dose twice per day (maximum daily dose 200 mg) for ≤45 kg, 100 mg twice daily if >45 kg for 5 to 7 days; continue for at least 3 days after defervescence and clinical improvement observed
Special Considerations: Chloramphenicol is the only known alternative agent to doxycycline for the treatment of RMS. Doxycycline is preferred, if chloramphenicol must be given the dose is 50 mg/kg per day in four divided doses (maximum 4 grams per day).