02/13/2025
The choice and duration of antibiotics for a wound infection depend on several factors, including the severity of the infection, the type of bacteria suspected or confirmed, the patient’s medical history, and any risk factors for complications. Here’s a general approach to decision-making:
1. Assess the Severity of the Infection
Mild infections: Localized redness, swelling, and minimal drainage without systemic symptoms.
Moderate infections: More pronounced redness, warmth, tenderness, and purulent drainage, possibly with mild systemic signs.
Severe infections: Spreading cellulitis, abscess formation, fever, chills, hemodynamic instability, or necrotizing fasciitis.
2. Consider the Type of Wound
Surgical wound: Common pathogens include Staphylococcus aureus (MSSA/MRSA) and Streptococcus species.
Traumatic wound: May include environmental contaminants like Pseudomonas aeruginosa or anaerobes.
Bite wounds: Human or animal bites often require coverage for Pasteurella, Eikenella, and anaerobes.
Diabetic foot ulcer: May involve polymicrobial infections, including anaerobes and resistant gram-negative bacteria.
3. Choose an Empiric Antibiotic Based on Likely Pathogens
Mild infections (oral antibiotics, 5–7 days):
Cephalexin (MSSA, Streptococcus)
Dicloxacillin (MSSA)
Clindamycin (MSSA, MRSA, Streptococcus)
TMP-SMX (Bactrim) (MRSA, but poor Streptococcus coverage)
Moderate infections (oral or IV, 7–10 days):
Amoxicillin-clavulanate (bite wounds)
Doxycycline (MRSA, some gram-negatives)
Clindamycin + cephalexin (MSSA, MRSA, Streptococcus)
IV cefazolin or vancomycin for inpatient treatment
Severe infections (IV antibiotics, 10–14 days, possibly longer for deep infections):
Vancomycin (MRSA)
Piperacillin-tazobactam (polymicrobial infections)
Meropenem (for resistant or severe infections)
Metronidazole (if anaerobic coverage is needed)
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