Management of Recurrent Skin Infections

Recurrent skin infections have always been a source of frustration in general practice but now, besides the normal frustration, we are also experiencing a steep increase of antibiotic resistance which is adding challenge to the management of these cases. The resistance could be due to a variety of reasons including widespread and not always appropriately done antibiotic use. For this reason, is very important to use antibiotics well, using the right dose, for the right amount of time, at the right dosing interval. Shorter courses of antibiotics combined with suboptimal doses allow bacteria to build resistance.

Some antibiotics are also more prone to induce resistance and others and in some cases they can induce resistance to antibiotics that had never been used before. For this reason it important to consider topical therapy as much as possible as use systemic antibiotics when really necessary. It is important to control inflammation in the skin to minimize the conditions that could lead to the development of a bacterial infection. As a general rule, superficial pyoderma should be treated for a minimum of 3 weeks or at least 7-10 days past resolution of all clinical signs. A narrow spectrum antibiotic should be preferred over a broad spectrum. Good choices for Staphylococcus would be first generation cephalosporines, clindamycin, lincomycin. Other good choices would be amoxicillin clavulanic acid keeping in mind that the dose used for skin infection is higher than the standard dose (22mg/kg BID vs the commonly used 14mg/kg BID). Third generation cephalosporines are not better than first generation to kill staphylococcus but can increase the risk for resistance due to the broader spectrum of action.  […]