Treatment of skin infections

New advice from NPS Medicinewise is available regarding treatment of skin and soft tissue infections, including bites. High rates of resistance are making it harder to empirically select antibiotics to treat Staphylococcus infections. As the skin is one of the most common sources of methicillin-resistant Staphylococcus aureus reduction of unnecessary prescribing for injuries could have a significant impact on antibiotic resistance rates.The advice suggests that low risk skin infections can be managed without antibiotics.

  • Most boils can be treated with incision and drainage without the need for antibiotics.
  • Usually, post-traumatic wounds that are not contaminated can be effectively treated with careful cleaning and debridement, elevation and immobilisation.
  • In otherwise healthy people with a low risk of infection, most bite and clenched fist injuries can be managed with good wound care alone.

First-line management for all bite and clenched fist injuries includes thorough cleaning, debridement, irrigation, elevation and immobilisation. Always check whether tetanus immunisation is up to date.

Prophylactic antibiotics are not always needed for animal bites but should be strongly considered for human bites. Human bites are more likely to be contaminated with gram negative and anaerobic organisms. The position of the bite can also play a role, with bites on the hand or face more likely to develop infections. For more advice on selecting an antibiotic see the Therapeutic Guidelines: Antibiotic.

While antibiotics are important, they should never take the place of proper wound management.

Picture credit: NPS MedicineWise, MedicineWise News, 13/11/15

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