Wednesday, July 30, 2014

Updated IDSA Soft Tissue Infection Guidelines

Our infectious disease experts have bestowed upon us an update in the management of skin and soft tissue infection.  This is particularly relevant in our new Age of MRSA, where over-reaction and antibiotic overuse has become the norm – and almost certain to usher in a new, more dire, era of resistant pathogens.

But, this update provides a lovely pathway describing the treatment options for SSTIs that, happily, includes many narrow spectrum antibiotics.  Non-abscess SSTIs may be managed with simple penicillins or first-generation beta-lactams.  Purulent pathology is managed simply by incision and drainage – and antibiotics added only in the setting of moderate or severe disease.  They also, importantly, note most impetigo should be treated solely with topical antibiotic ointment.

There are a handful of odd statements, however.  Cultures are still recommended, but the authors acknowledge treatment is reasonable without.  Considering avoidance of cultures in uncomplicated SSTI is part of ACEP’s Choosing Wisely Recommendations, I’d prefer to see revised phrasing from the authors in the associated passages.  Recommendations for antibiotic prophylaxis after dog and cat bites appropriately require specific risk-factors for superinfection, but may yet still be overly broad.  At least, however, the level of evidence supporting their recommendation is appropriately cited as “low”.

And, of course, it’s always nice to be reminded of the appropriate treatment of glanders.

Finally, the recommendations do not overtly appear to reflect the influence of financial conflicts, despite many authors declaring substantial COI.

“Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America”

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