Source control and wound care
›Drainage and debridement
›Incision and drainage for abscess
›Culture of purulent material
›Loculation breakdown
›Debridement for devitalized tissue
›Surgical consultation for extensive necrosis
›Foreign body removal
›Imaging guided removal when deep
›Local wound management
›Irrigation with sterile saline
›High pressure irrigation for contaminated wounds when appropriate
›Dressing strategy
›Moist wound healing principles
›Elevation of affected limb
›Edema reduction support
Antibiotics for nonpurulent infection
›Mild cellulitis without systemic toxicity
›Cephalexin PO 500 mg every 6 hours
›Duration 5 days
›Extend to 7 to 10 days if slow response
›Cefadroxil PO 1 g daily
›Alternative for adherence
›Penicillin allergy nonanaphylaxis
›Cefazolin tolerance consideration based on reaction type
›Penicillin anaphylaxis
›Clindamycin PO 300 mg every 6 to 8 hours
›Moderate to severe nonpurulent infection
›Cefazolin IV 2 g every 8 hours
›Step down to oral when improving
›If MRSA risk, add MRSA active agent
›Vancomycin IV 15 to 20 mg/kg every 8 to 12 hours
›Trough guided dosing per local protocol
›Renal adjustment
›Linezolid IV or PO 600 mg every 12 hours
›Serotonergic interaction review
Antibiotics for purulent infection
›Abscess with minimal cellulitis
›Incision and drainage alone
›No antibiotics for small abscess in healthy host
›Antibiotics for higher risk features
›Multiple lesions
›Extensive surrounding cellulitis
›Systemic toxicity
›Outpatient MRSA coverage options
›Trimethoprim-sulfamethoxazole PO 1 to 2 DS tablets every 12 hours
›Duration 5 to 7 days
›Renal adjustment
›Doxycycline PO 100 mg every 12 hours
›Avoid in pregnancy and young children
›Clindamycin PO 300 to 450 mg every 6 to 8 hours
›C difficile risk counseling
›Severe purulent infection
›Vancomycin IV 15 to 20 mg/kg every 8 to 12 hours
›Target AUC based dosing per local protocol
›Alternative for vancomycin intolerance
›Daptomycin IV 4 mg/kg daily
›CK monitoring
Polymicrobial and special exposure regimens
›Surgical site infection with deep involvement
›Broad spectrum coverage pending source control
›Piperacillin-tazobactam IV 4.5 g every 6 hours
›Renal adjustment
›Add vancomycin if MRSA risk
›Vancomycin IV regimen as above
›Bite wound infection
›Amoxicillin-clavulanate PO 875 mg every 12 hours
›Duration 5 to 7 days
›Penicillin anaphylaxis alternative
›Doxycycline PO 100 mg every 12 hours
›Avoid in pregnancy and young children
›Add metronidazole PO 500 mg every 12 hours for anaerobe coverage
›Saltwater exposure
›Doxycycline PO or IV 100 mg every 12 hours
›Add third generation cephalosporin for severe infection
›Ceftriaxone IV 2 g daily
›Freshwater exposure
›Ciprofloxacin PO 500 mg every 12 hours
›Tendinopathy risk counseling
›Necrotizing infection concern
›Immediate broad spectrum plus toxin suppression
›Piperacillin-tazobactam IV 4.5 g every 6 hours
›Renal adjustment
›Clindamycin IV 900 mg every 8 hours
›Streptococcal toxin suppression concept
›Vancomycin IV regimen as above
›MRSA coverage
›Immediate surgical consultation
›Debridement as definitive therapy
Analgesia, antipyresis, and supportive care
›Pain control
›Acetaminophen PO 1000 mg every 6 to 8 hours
›Maximum 3000 mg/day if risk factors for hepatotoxicity
›Ibuprofen PO 400 mg every 6 to 8 hours
›Avoid in significant renal dysfunction
›Opioid for severe pain when needed
›Hydromorphone PO 1 to 2 mg every 4 to 6 hours as needed
›Tetanus prophylaxis
›Vaccination status review
›Booster if not up to date based on wound type and timing
›Glycemic optimization
›Hyperglycemia correction in diabetics
›Inpatient insulin protocol when admitted