Patient Care and Monitoring

Choosing antibiotic therapy for SSTIs:

1. To select the most effective empirical antibiotic agent(s) for SSTIs, review the following:

• The diagnosis

• Clinical manifestations and severity of illness (to assess the need for IV versus oral therapy).

• Past medical history, chronic disease states (to determine suspected pathogens).

• Patient's ability to adhere to the regimen (if outpatient treatment indicated).

In pediatric patients especially, consider duration of therapy, frequency of dosing, method and ease of administration, and palatability and tolerability of oral formulations.

2. To ensure the safety of your selected antibiotic agent(s), review the following:

• Current medications (over-the-counter, prescription, and alternative) for potential drug interactions.

• History of medication allergies and adverse effects.

• Current laboratory analyses to determine renal and hepatic function.

• Chronic disease states or acute conditions that could be worsened by certain antimicrobial agents (e.g., QT prolongation or acute renal failure).

• Other disease modifiers that may preclude use (e.g., pregnancy, age). Monitoring antibiotic therapy for SSTIs:

1. Ensure that antimicrobial therapy is effective by monitoring for:

• Resolution of local and systemic signs and symptoms of infection.

• Resolution of laboratory evidence of infection.

2. Narrow antibiotic coverage when possible with the use of culture and sensitivity data.

3. Assess patient adherence.

4. Ensure that antimicrobial therapy is safe by monitoring for and treating (as appropriate):

• Common and severe adverse effects.

• Drug interactions.

Patient education regarding antibiotic therapy for SSTIs:

1. It is imperative to take the antibiotic as prescribed and to finish the therapy.

2. If no symptomatic improvement is noted within 3 days, contact your health care provider.

3. Many antibiotics cause diarrhea. If it is severe, contact your health care provider.

4. Consider health initiatives to improve wound healing, such as smoking cessation and glycemic control.

If the wound is associated with significant cellulitis and edema, systemic signs of infection, or possible joint or bone involvement, hospitalization and IV antibiotics (typically ampicillin-sulbactam 3 g IV every 6 hours) should be initiated. Bone and joint infections will require longer durations of therapy of up to 6 weeks.49

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