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Skin (Cellulitis, erysipelas)  Possible therapeutic alternatives
Cellulitis (extremities): No risk factors. Mild cases .

Treatment duration: 
7 - 10 days

Common pathogens
Dicloxacillin 500mg orally four times daily or
Penicillin VK 500mg orally every 6 hours 
Erythromycin 500mg orally or IV every 6 hours or 
Augmentin 500mg orally three times daily or 875/125mg orally q12h
Azithromycin 500mg x 1, then 250mg once daily or 
Cephalexin 250-500mg orally every 6 hours or
Cefadroxil 500mg-1g orally every 12 hours or Cefuroxime 250-500mg orally every 12 hours or  Cefprozil 250-500mg orally once or twice daily or
Levofloxacin 250 - 500mg orally once daily or
Moxifloxacin (Avelox) 400mg orally once daily or
Cefazolin 1 gram ivpb every 8 hours or
Nafcillin 1-2 grams IV every 4 or 6 hours
Erysipelas (sharply demarcated borders)

 

Treatment duration: 
7 - 10 days

Common pathogens
Dicloxacillin 500mg orally four times daily or
Clindamycin 300mg orally four times daily or if severe 600mg IV every 6 hours or
Augmentin 500mg orally three times daily or
Azithromycin 500mg x 1, then 250mg once daily or 
Erythromycin 500mg orally or IV every 6 hours or 
Cephalexin (Keflex ®) 250-500mg orally every 6 hours or
Cefadroxil 500mg-1g orally every 12 hours or Cefuroxime 250-500mg orally every 12 hours or  Cefprozil 250-500mg orally once or twice daily.
Cefazolin 1 gram ivpb every 8 hours
Cellulitis: (Risk factors), Diabetes mellitus, Immunosuppressed, ulcerated lesions. Common pathogens
Early/mild:
Cefotetan 1-2 grams ivpb every 12 hours or
Ampicillin-sulbactam 1.5 - 3 grams  ivpb every 6 hours  or 
Augmentin 500mg orally three times daily or 875/125mg orally q12h
Severe penicillin allergy:
Vancomycin 1 gram  ivpb q12h + Gentamicin  +/-  Metronidazole

Cellulitis

Erysipelas 

 

 

 

 

Antimicrobial Series
References

American Hospital Formulary Service.  Drug Information. Bethesda, MD: ASHP, 1997.
Baden LR, Eisenstein BI.Impact of Antibiotic Resistance on the Treatment of Gram-negative Sepsis.
Curr Infect Dis Rep. 2000 Oct;2(5):409-416.
Bartlett JG et al. Community-acquired pneumonia in adults: guidelines for management. Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 1998;26:811-38.
Bartlett JG: Empirical therapy of community-acquired pneumonia: macrolides are not ideal choices. Semin Respir Infect 1997 Dec; 12(4): 329-33
Bartlett JG.1998 Pocket Book of Infectious Disease Therapy., Ninth Edition. Baltimore,MD: Williams&Wikins,1998.
Bernstein JM: Treatment of community-acquired pneumonia--IDSA guidelines. Infectious Diseases Society of America. Chest 1999 Mar; 115(3 Suppl): 9S-13S
Drug Information Handbook, 5th Ed. 1997, Lexi-Comp inc. 
Ewig S et al. Pneumonia acquired in the community through drug-resistant Streptococcus pneumoniae. Am J Respir Crit Care Med. 1999;159:1835-42.
File TM Jr. Community-acquired pneumonia: recent guidelines for therapy. J Respir Dis. 1999;20:534-41.
Gilbert DN, Moellering RC, Sande MA. The Sanford Guide to Antimicrobial Therapy 2000. 30th ed. Hyde Park,VT: Antimicrobial Therapy, Inc.; 2000.
Gold HS, Moellering RC. Antimicrobial-drug resistance. N Engl J Med. 1996;335:1445-1453.
Gonzales R, Sande M: What will it take to stop physicians from prescribing antibiotics in acute bronchitis? Lancet 1995 Mar 18; 345(8951): 665-6
Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated urinary tract infection. Infect Dis Clin North Am 1997;11:551-581.
Lipsky BA, Berendt AR.Principles and practice of antibiotic therapy of diabetic foot infections.
Diabetes Metab Res Rev. 2000 Sep-Oct;16 Suppl 1:S42-6.
Mufson MA.Pneumococcal Pneumonia.
Curr Infect Dis Rep. 1999 Apr;1(1):57-64.
Reese RE, Betts RF: A Practical Approach to Infectious Diseases. 4th ed. Boston: Little, Brown, and Company; 1996: 251
Stefani SD, Cadore LP, Villaroel RU, Azevedo S, Machado AL. Antibiotic Selection in the Treatment of Febrile Neutropenia: Current Approach and New Directions.
Braz J Infect Dis. 1998 Jun;2(3):109-117.
Stamm WE, Hooton TM. Management of urinary tract infections in adults. N Engl J Med 1993;329:1328-1334.

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