Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

Superficial

Debridement and Cultures

Debridement if indicated

  • Please send deep tissue cultures upon debridement, preferably prior to starting antibiotics in the clinically stable patient

  • Superficial swab cultures have poor correlation with deep tissue cultures except Staphylococcus aureus

Empiric Therapy

Cefazolin 1-2G IV Q8h

Use 2G if weight >80kg

OR

Vancomycin 15 mg/kg IV Q8h

  • If methicillin-resistant Staphylococcus aureus (MRSA) is suspected (known colonization, prior MRSA infections, etc.)

  • Loading dose of 20 mg/kg once is recommended

  • Q8h dosing preferred in young adults

OR

Clindamycin 600-900mg IV Q8h

Alternative for severe penicillin allergy (i.e. anaphylaxis, angioedema, hives, etc.)

De-escalation to PO Antibiotics

Cephalexin 500mg PO Q6h

OR

TMP-SMZ 1-2 DS tabs Q12h

If methicillin-resistant Staphylococcus aureus (MRSA) is suspected (known colonization, prior MRSA infections, etc.)

OR

Clindamycin 300-450mg PO Q6-8h

  • Alternative for severe penicillin allergy (i.e. anaphylaxis, angioedema, hives, etc.)

  • Or if methicillin-resistant Staphylococcus aureus (MRSA) is suspected (known colonization, prior MRSA infections, etc.)

OR

Doxycycline 100mg PO Q12h

  • Alternative for severe penicillin allergy (i.e. anaphylaxis, angioedema, hives, etc.)

  • Or if methicillin-resistant Staphylococcus aureus (MRSA) is suspected (known colonization, prior MRSA infections, etc.)