Treatment

Question 1

What are the two main principles when treating a bacterial skin infection?

Answer 1

Source control - surgical debridement or removal of any abscesses

Antimicrobials

Question 2

What are some examples of oral antibiotics used to treat skin and soft tissue infections?

Answer 2

Penicillin - Flucloxacillin

Tetracyclines - Doxycycline

Macrolides - Clarithromycin/ Erythromycin

Question 3

In patients with severe skin and soft tissue infection, these antibiotics may be used:

Tazocin
Clindamicin
Gentamicin

What is the general indication for each one?

Answer 3

Tazocin
Covers Staph aureus and Strep infections very well
Also covers some gram negative bacteria like Pseudomonas

Clindamicin
Covers Staph aureus and Strep infections very well
Can inactivate their toxins

Gentamicin
Covers gram negative infections

Question 4

When deciding whether to give someone antibiotics orally or intravenously, what factors do you consider?

Answer 4

Likely source - has this been controlled. A large abscess will never be treated by prolonged antibiotics. It must be lanced or debrided.

Absorption - will they absorb the antibiotic orally

Penetration - will antibiotic get to where it needs to go. Antibiotics do not penetrate abscesses well

Previous resistance results – e.g MRSA

How unwell – Eron classification

Co-morbidities - frailer patients may be higher risk of dying, if not treated aggressively

If a patient is unwell, it is common to start antibiotics IV, and review this decision at 48 hours. At this point bloods/ imaging/ microbiology results are available, and patient progress clinically can be assessed. Antibiotics can then be continued IV, swapped to oral, or stopped altogether

Question 5

When should you phone microbiology for advice regarding an infection?

Answer 5

Very unwell – e.g necrotising fasciitis

Unusual exposure – foreign travel, water exposure, animal exposure

Not improving on current therapy

Allergies

Empirical guidelines are designed to treat most common infections. They should be used for initial treatment with confidence.

If a patient is unwell 10 hours after starting antibiotics, this does not necessarily mean the antibiotics aren’t working. The knee-jerk reaction is always to change antibiotics