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Skin and Soft Tissue Infections (SSTIs)
Common SSTIs
- Furuncles
Furuncle (boil) is a deep, necrotizing form of folliculitis with involvement of the subcutaneous tissue. A furuncle is manifested by a tender, round, subcutaneous nodule, which is usually capped with a small pustule. 4
- Carbuncles
A carbuncle with multiple draining sites is found commonly on the neck, back and thighs. Several furuncles may coalesce to form a carbuncle. 4
- Cutaneous Abscesses
Is a painful collection of pus that is caused by a bacterial infection. An abscess often appears as a swollen, pus-filled lump under the surface of the skin, or it may look more like an open break in the skin. 5
- Infected Wound
Is a localized defect or excavation of the skin or underlying soft tissue in which pathogenic organisms have invaded into viable tissue surrounding the wound. 6
Causative Pathogen
- Acute bacterial skin and soft tissue infections are caused primarily by Gram-Positive cocci, particularly Staphylococcus aureus and Streptococcus pyogenes. 2
- According to PSAP-Infectious diseases 2015: S. aureus is the most common cause of furuncles, carbuncles, cutaneous abscesses. 2
- S. aureus is the most common identified causative agent, accounting for more than 40% of all SSTI cases. 7
- Empiric antimicrobial therapy should be directed at the most likely pathogens (e.g. Staphylococcus aureus and Streptococcus pyogenes) 8
Treatment Guidelines
- According to recommendations in Journal Annals of Dermatology 2018: first-generation cephalosporins may be the most effective first-line empirical regimen for bacterial skin infections treated in outpatient settings. 9
- Guidelines by Infectious Disease Society of Korea 2017 recommend first-generation cephalosporins like Cephradine as one of the treatment options for purulent SSTI 10
- American Academy of Family Physicians 2015 recommend that first generation cephalosporins can be antibiotic of choice in young and adult patients with mild and moderate SSTIs 11
According to the Sanford Guide 2020,10 Spectrum of First Generation Cephalosporins include 12
| Gram +ve | Gram -ve | ||
|---|---|---|---|
| Staph. aureus (MSSA) | ++ | + | Klebsiella spp |
| Coagulase-Negative Staph. | ++ | + | E. coli |
| Strep. Group A,B,C & G | + | + | Proteus mirabilis |
| Strep. Pneumoniae | + | ||
| ++ = Recommended | + = Active |
Velosef (Cephradine) is indicated for skin and soft tissue infections like abscess, cellulitis and furunculosis 13
References:
- IQVIA MIP S1 2021.
- Chahine EB;Infectious Diseases;2015; 5—26.
- StatPearls;Winters RD; 2019; 1-7.
- European Handbook of Dermatological treatment; Furuncles and carbuncles; loannides D; 2003; 173—176.
- NHS Foundation Trust; 2012; 1-4; Abscess.
- Wound Source; 2020; 1-10; Infected Wounds.
- Tognetti L; Journal of the European Academy of Dermatology and Venereology; 2012; 26; 931-941.
- Hedrick J; Pediatric drugs; 2003; 5; 35-46.
- Lim JS; Ann Dermatol; 2018; 30; 186-191.
- Kwak YG; Infection & chemotherapy; 2017; 49; 301-325.
- KALYANAKRISHNAN RAMAKRISHNAN; American Family Physician; 2015; 92(6); 475-483
- David N et al : The Sanford Guide 50th edition 2020
- Velosef Data Sheet, NCDS, Version Number 05, Version Date: 13th February 2020
