Guidelines: Many Skin Infections Do Not Require Antibiotics

Most skin and soft tissue infections (SSTIs) are mild and will heal on their own without the use of antibiotics, according to new guidelines from the Infectious Diseases Society of America.

The guidelines update recommendations from 2005, and focus on helping physicians determine when antibiotics are necessary when treating patients with SSTIs. 

Within the guidelines, SSTIs are categorized as either purulent or nonpurulent, and offers charts and algorithms for assessing the proper form of treatment for each.
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Many purulent infections, they explain, are mild and require minimal treatment. Treatment of moderate purulent infections should involve drainage and culture testing, with antibiotics used as needed.

In severe infections—an infection that remains despite drainage and oral antibiotics or in which symptoms include a fever, elevated heart and breath rates, or high white blood cell count—the guidelines recommend specific treatments based on which pathogen is identified.   

Mild and moderate nonpurulent SSTIs are defined as cellulitis or erysipelas, and should be treated with oral antibiotics. In patients with bullae, skin sloughing, hypotension, organ dysfunction, or high temperature, severe infection should be suspected.

In these patients, the guidelines suggest surgical inspection, followed by empiric treatment with vancomycin and piperacillin/tazobactam.

“Previously, the empiric treatment of SSTIs of endogenous origin was relatively easy because semisynthetic penicillin, cephalosporins, erythromycin, and clindamycin were effective treatment of both S. aureus and Streptococcal species,” researchers concluded.

“In the future it will be more important than ever to base treatment on cultures and sensitivities.”

The full guidelines are published in Clinical Infectious Diseases.

–Michael Potts

Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis. 2014 June 18 [epub ahead of print] doi: 10.1093/cid/ciu296