Skin & Soft Tissue Infection (SSTI) Protocol

Diagnostic sorting, triage pathways, and clinical antibiotic selections.

🔍 Initial Signs & Systemic Triage

Identify localized presentation vs. systemic compromise requiring immediate hospitalization.

SSTI Presentation Indicators:

Erythema, swelling, increased temperature, pain, tenderness on palpation, and fever.

🔴 YES: Severe Infection / Systemic Illness

Admit to Hospital:

Signs of systemic toxicity or evolving sepsis.
Spreading severe infection failing initial primary care interventions.

🟢 NO: Localized Presentation

Proceed with Outpatient Care:

No systemic signs or severe infection.
Proceed to check for fluctuancy to classify the pathology.

Fluctuant Present

🎯 Abscess Pathway

Primary intervention requires mechanical decompression followed by selective anti-microbial evaluation.

Primary Intervention:

Perform Incision & Drainage (I&D) as the core therapy for confirmed abscesses.

Antibiotic therapy is indicated ONLY if the patient presents with:

Extensive surrounding cellulitis.
Inadequate localized surgical drainage.
Co-existing Diabetes Mellitus.
Co-existing Valvular Heart Disease.

⚠️ CRITICAL: Always collect pus for Gram Stain and Culture & Sensitivity (C&S) BEFORE initiating the first antibiotic dose.

Abscess Outpatient Antibiotic Dosing (5 – 7 Days)

Antibiotic Options	Dosing Regimen	Duration	Remarks
Cephalexin	1000mg PO q12h	5 – 7 Days	Indicated if criteria met
Cloxacillin	500mg PO q6h	5 – 7 Days	Indicated if criteria met
Amoxicillin / Clavulanate	625mg PO q8h	5 – 7 Days	Indicated if criteria met

Fluctuant Absent

🎯 Cellulitis Pathway

Non-fluctuant localized spreading erythema and soft tissue inflammation.

Cellulitis Outpatient Antibiotic Dosing (5 – 10 Days)

Antimicrobial Selection	Dosing Regimen	Duration	Remarks
Cephalexin	1000mg PO q12h	5 – 10 Days	Preferred
Cloxacillin	500mg PO q6h	5 – 10 Days	Preferred
Amoxicillin	500mg PO q8h	5 – 10 Days	Preferred
Amoxicillin / Clavulanate	625mg PO q8h	5 – 10 Days	Alternative
Ampicillin / Sulbactam	375mg PO q12h	5 – 10 Days	Alternative

Superficial Lesions

🎯 Impetigo Pathway

Differentiate localized vs. generalized presentations to limit antimicrobial resistance risks.

🟢 Localized Lesions

Topical 2% Fusidic Acid: Apply q8-12h for 5 days.

OR Topical 2% Mupirocin: Apply q8h for 5 days.

*Stewardship Note: Reserve topical antibiotics for localized lesions to reduce the risk of bacteria becoming resistant (e.g., MRSA).

🟡 Generalized Lesions

Systemic oral therapy required. Course duration: 5 – 7 days.

Review the full oral dosing selections mapped in the registry table below.

Generalized Impetigo Oral Therapy (5 – 7 Days)

Antimicrobial Selection	Dosing Regimen	Duration	Remarks
Cephalexin	1000mg PO q12h	5 – 7 Days	Preferred Choice
Cloxacillin	500mg PO q6h	5 – 7 Days	Preferred Choice
Amoxicillin / Clavulanate	625mg PO q8h	5 – 7 Days	Alternative
Erythromycin Ethylsuccinate	800mg PO q12h	5 – 7 Days	Penicillin Allergy Choice

👶 Pediatric Antimicrobial Dosing Directory

Dosing guide for children presenting with an abscess, impetigo, or cellulitis.

Weight Threshold Rule:

These pediatric per-kilogram parameters apply explicitly to children weighing less than 25kg.

For pediatric patients weighing 25kg or more, shift entirely to standard adult outpatient dosing (e.g., Cloxacillin 500mg PO q6h).

Antibiotic Choice	Weight-Based Outpatient Dosing	Duration	Max Limits & Remarks
Cephalexin	25 – 50 mg/kg/day PO split q12h	5 – 7 Days	Preferred Absolute Max: 2gm / day
Cloxacillin	50 – 100 mg/kg/day PO split q6h	5 – 7 Days	Preferred Max Capped by Indication: Abscess & Cellulitis: 2gm / day Impetigo: 1gm / day

*Stewardship Rule: For localized pediatric impetigo presentations, avoid initial oral pathways and use targeted topical therapies (e.g., Fusidic Acid).