Cellulitis:
- Usually staph or strep
- Treat for 5-10 days
- PenG if confirmed Strep
- cefazolin, cephalexin
- ceftriaxone
- clindamycin
- Treat for MRSA if penetrating trauma, injectable drug use, purulent drainage, nasal colonization or other evidence of MRSA.
- clindamycin, Bactrim or doxycycline with Beta-lactam.
Erysipelas:
- Superficial dermis infection, usually on legs and feet. Has a distinct raised border (look for that in questions)
- Treat for 5 days with PenG or clindamycin
Necrotizing Fascitis:
- Involved subcutaneous fat and superficial fascia. Usuallly S. pyogenes (produces toxins), but can be MRSA, V. vulnificus (ocean water), A. hydrophilia (freshwater), Peptostreptococcus or other mixed anaerobes.
- Treatment:
- Debridement is necessary, antibiotics alone will not cure.
- Empiric:
- Vancomycin or linezolid or daptomycin (MRSA agents) plus
- pip/tazo or a carbapenem or ceftriaxone AND metronidazole or a fluoroquinolone AND metronidazole
- If Group A strep or clostridia suspected, include clindamycin to suppress streptococcal toxin and cytokine production.
- Confirmed Strep necrotizing fasciitis: High dose penicillin plus clindamycin