Ulcer, drainage, fistula
[Clin Infect Dis 2023; ciad527, https://doi.org/10.1093/cid/ciad527]
- Monitor renal function and adjust dosing of antibiotics according to renal function.
- Switch to oral therapy should be guided by clinical improvement and deep tissue culture & susceptibility results.
Usual Pathogens
Polymicrobial:
S. aureus/MRSA
S. epidermidis
ß-haemolytic Streptococci (group A,B,C,G)
Enterococcus spp
Enterobacterales
Pseudomonas spp
Anaerobes (cover if chronic or necrotic, foul-smelling infection, or if peripheral vascular disease)
Debridement & Glycemic control
Mild
| Empiric Therapy | Duration | |
|---|---|---|
| Amoxicillin-clavulanate | 875mg PO bid |
Penicillin/amoxicillin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Cefuroxime axetil | 500mg PO bid | 7-10 days |
| + | ||
| Metronidazole | 500mg PO bid |
Cefuroxime allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Doxycycline | 100mg PO bid | |
| + | ||
| Metronidazole | 500mg PO bid |
MRSA suspected
| Empiric Therapy | Duration | |
|---|---|---|
| Amoxicillin-clavulanate | 875mg PO bid | |
| + |
|
|
| TMP/SMX | 2DS tabs PO bid |
|
| Amoxicillin/penicillin allergy |
|
|
| Doxycycline | 100mg PO bid | |
| + |
|
|
| Metronidazole | 500mg PO bid |
|
Moderate-severe
| Empiric Therapy | Duration | |
|---|---|---|
| Cefazolin | 2g IV q8h | |
| + | ||
| Metronidazole | 500mg PO bid |
Cefazolin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Ceftriaxone | 2g IV daily | 10 days |
| + | ||
| Metronidazole IV/PO | 500mg PO/IV q12h |
Outpatient and failure of oral therapy or known/suspected ESBL/Amp C-producing organisms or ceftriaxone-resistant organisms
| Empiric Therapy | Duration | |
|---|---|---|
| Ertapenem | 1g IV daily | 2-3 weeks |
MRSA suspected - Moderate-severe
| Empiric Therapy | Duration | |
|---|---|---|
| Vancomycin | 15mg/kg IV q12h | 2-3 weeks |
| + | ||
| Ceftriaxone | 1g IV daily | |
| + | ||
| Metronidazole IV/PO | 500mg PO/IV q12h |
Limb-threatening
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Piperacillin-tazobactam | 3.375g IV q6h | 2-3 weeks |
| + | ||
| Vancomycin | 15mg/kg IV q12h | |
| Penicillin allergy | ||
| Meropenem | 500mg IV q6h | |
| + | ||
| Vancomycin | 15mg/kg IV q12h |