SSTI + Mixed Bacterial Infection

Suspected Microbes

Varies by setting

Initial Treatment

  • Dose adjustment required in renal impairment

WITH OR WITHOUT

  • If toxic shock syndrome or necrotizing fasciitis

Alternatives if Type-1 Immediate Penicillin Allergy

PLUS

WITH OR WITHOUT

  • If toxic shock syndrome or necrotizing fasciitis

ALTERNATIVELY, CONSIDER

  • Dose adjustment required for renal dysfunction.

  • If known/suspected infection with a multi-drug resistant Gram-negative organism (e.g. ESBL/AmpC).

WITH OR WITHOUT

  • If toxic shock syndrome or necrotizing fasciitis

If Risk Factors for MRSA, then consider ADDING to the above regimens:

  • Target trough: 10 to 15 mg/L

  • Consider capping the loading dose at a maximum of 3,000 mg and maintenance doses at a maximum of 2,000 mg.

  • Dose adjustment required in renal dysfunction.

  • History of MRSA infection or colonization

  • Household contact with a MRSA colonized individual

  • IV drug use

  • Homelessness

  • Incarcerated persons

  • Recent travel to or residing in an MRSA endemic region or community

Additional Information

  • Blood cultures (2 sets)

  • Urgent surgical assessment for diagnostic biopsy and/or debridement

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