Download PAMC Guideline for OUTPATIENT/EMERGENCY DEPARTMENT

PAMC Guideline for OUTPATIENT/EMERGENCY DEPARTMENT Uncomplicated Skin and Soft Tissue Infection (SSTI)
This guideline should NOT be used for the following:
Infected diabetic ulcers or ulcers secondary to
Human or animal bites
Bacteremia associated with skin and soft
vascular disease
tissue infection
Periorbital or orbital cellulitis
When concern exists for necrotizing fasciitis
IV drug abuse
Perineal, vulvar, or perianal infections
Deep tissue infection
Pregnancy
Surgical site infections
Critical Illness
Note: Presence of complicating risk factors requires alternative treatment strategies and often warrants formal infectious disease consultation.
Key Points:
The following are NOT routinely indicated for initial management:
Beta-hemolytic streptococci are the most common cause of non-purulent cellulitis
ESR/CRP
MRSA is the most common cause of abscess and purulent skin infections
Blood cultures
Gram-negative or anaerobic coverage is unnecessary
Wound swab, fungal, or AFB cultures
The affected area should be elevated
Plain films, CT, or MRI
Hospital Admission Criteria:
Patients should be considered for inpatient admission if any of the following are present: severe disease, failure of outpatient antibiotics, hemodynamic
instability, elevated CPK, low serum bicarbonate, severe immune compromise, poor adherence to therapy, or marked left shift. (Refer to PAMC Inpatient
Uncomplicated SSTI Clinical Pathway)
In a majority of patients who may be treated on an OUTPATIENT basis antibiotics should be given orally. Outpatient IV antibiotic therapy administered via
home nursing, the emergency department, and/or infusion centers is generally NOT recommended for patients who do NOT warrant hospital admission.
Outpatient
Suspected Pathogen(s)
Recommended Treatment
Other Comments
Cellulitis
Beta-hemolytic Streptococci
Supportive Care:
Duration of therapy: 5-7 days
WITHOUT
(Most commonly Group A, also
Elevate affected area
purulent
Group B, Group C, Group G)
Preferred Antibiotic:
focus
Cephalexin 500 mg – 1 gm PO TID
Type-1 Beta-Lactam Allergy:
Clindamycin 450 mg PO TID
Cellulitis
Beta-hemolytic streptococci,
Supportive Care:
Drainage is the most important
WITH
Methicillin susceptible
intervention. Antibiotics may NOT be
I&D - Send purulence for gram-stain/culture
purulent
Staphylococcus aureus (MSSA),
necessary for drained abscesses without
Elevate affected area
focus
Methicillin resistant
surrounding induration or erythema.
Staphylococcus aureus (MRSA) Preferred Antibiotic: (If Indicated)
Duration of therapy: 5-7 days
TMP/SMX DS 1 tab PO BID
Sulfa Allergy/Type-1 Beta-Lactam Allergy:
Note: Recurrent MRSA infections need
Clindamycin 450 mg PO TID
not be cultured at every presentation.
OR
Doxycycline 100 mg PO BID
Updated 9/2014