Involving perineum, GI tract, female genital tract, axilla
- Anaerobic coverage is recommended.
- Cephalosporins and clindamycin have no activity against Enterococcus spp.
- Switch to oral therapy after 48-72h if clinical improvement.
Usual Pathogens
Polymicrobial:
S. aureus/MRSA
ß-haemolytic Streptococci (group A, B, C, G)
Enterococcus spp
Enterobacterales
Anaerobes
Mild
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Amoxicillin-clavulanate | 875mg PO bid | 5-10 days or until patient afebrile and wound granulating |
Penicillin/amoxicillin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Cefuroxime axetil | 500mg PO bid | 5-10 days or until patient afebrile and wound granulating |
| + | ||
| Metronidazole | 500mg PO bid |
MRSA suspected
| Empiric Therapy | Duration | |
|---|---|---|
| Amoxicillin-clavulanate | 875mg PO bid | 5-10 days or until patient afebrile and wound granulating |
| + | ||
| TMP/SMX | 1-2 DS tabs PO bid |
Penicillin/amoxicillin allergy and MRSA suspected
| Empiric Therapy | Duration | |
|---|---|---|
| TMP/SMX | 1-2 DS tabs PO bid | 5-10 days or until patient afebrile and wound granulating |
| + | ||
| Metronidazole | 500mg PO bid |
Moderate
| Empiric Therapy | Duration | |
|---|---|---|
| Cefazolin | 2g IV q8h | 5-10 days or until patient afebrile and wound granulating |
| + | ||
| Metronidazole | 500mg PO bid |
Severe
| Empiric Therapy | Duration | |
|---|---|---|
| Piperacillin-tazobactam | 3.375g IV q6h | 5-10 days or until patient afebrile and wound granulating |
Severe and MRSA suspected
| Empiric Therapy | Duration | |
|---|---|---|
| Piperacillin-tazobactam | 3.375g IV q6h | 5-10 days or until patient afebrile and wound granulating |
| + | ||
| Vancomycin | 15mg/kg IV q12h |
Penicillin allergy and MRSA suspected
| Empiric Therapy | Duration | |
|---|---|---|
| Imipenem | 500mg IV q6h | 5-10 days or until patient afebrile and wound granulating |
| + | ||
| Vancomycin | 15mg/kg IV q12h |