Infection developing in damaged skin

Infections developing in damaged skin are a heterogeneous group that includes bite wounds (animal and human bites), burn wounds, and pressure ulcers. If managed incorrectly, these infections can develop into more complicated soft-tissue infections.


Irrigation of the wound and debridement of necrotic tissue are the most important factors in the prevention of infection and can substantially decrease the incidence of invasive wound infection. Antibiotic prophylaxis is not generally recommended. A broad-spectrum antibiotic effective against aerobic, and anaerobic organisms is required for patients with systemic signs of infection, compromised immune status, severe comorbidities, associated severe cellulitis, severe and deep wounds.

If antibiotics are necessary

One of the following antibiotics

Amoxicillin/clavulanate 1.2-2.2 g 8-hourly

Piperacillin/Tazobactam 4.5 g 6-hourly (in critically ill patients)

Ceftriazone 2 g 24-hourly + Metronidazole 500 mg 6-hourly

Cefotaxime 2g 8-hourly + Metronidazole 500 mg 6-hourly


In patients with beta-lactam allergy

Ciprofloxacin 400 mg 8/12-hourly + Metronidazole 500 mg 6- hourly

In patients at risk for CA-MRSA or who do not respond to first line therapy consider anti- MRSA antibiotics

Oral options:

Minocycline100 mg 12-hourly

Trimethoprim and sulfamethoxazole 160/800 mg 12-hourly

Doxycycline 100 mg 12-hourly

Clindamycin 300–600 mg 8-hourly (high resistance rate)

Linezolid 600 mg 12-hourly

Tedizolid 200 mg 24-hourly

Intravenous options:

Vancomycin 25–30 mg/kg loading dose then 15–20 mg/kg/dose 8-hourly

Teicoplanin LD 12 mg/kg 12-hourly for 3 doses, then 6 mg/kg 12-hourly

Tigecycline 100 mg as a single dose, then 50 mg 12-hourly

Linezolid 600 mg 12-hourly

Daptomycin 4–6 mg/kg 24-hourly

Ceftaroline 600 mg 12-hourly

Dalbavancin 1000 mg once followed by 500 mg after 1 week or 1500 mg one dose

Tedizolid 200 mg 24-hourly

Televancin 10 mg/kg 24-hourly