Skin Infections and Outpatient Burn Management: Bacterial Skin Infections

Patients with bacterial skin and soft tissue infections (SSTIs) commonly present to family physicians. Common uncomplicated bacterial SSTIs include impetigo, ecthyma, cellulitis, erysipelas, abscesses, furuncles, and carbuncles. Risk factors for SSTIs include older age and chronic medical conditions, such as diabetes and cardiopulmonary or renal disease, and immunocompromise. Staphylococci and streptococci are the most common pathogens. Uncomplicated impetigo and ecthyma can be managed with topical antibiotics. Oral antibiotics should be prescribed for patients with complicated impetigo and ecthyma and for patients with cellulitis. For patients with cellulitis and systemic signs of infection, systemic antibiotics are indicated but hospitalization or intravenous administration may not be required. Erysipelas can be managed with oral or intravenous penicillin. Purulent SSTIs by definition involve collections of pus and include abscesses, furuncles, and carbuncles. Larger abscesses are appropriate for incision and drainage. Patients with uncomplicated carbuncles or abscesses may not require antibiotics afterward. However, antibiotics are recommended for patients with systemic inflammatory response syndrome (SIRS), patients with carbuncles or abscesses who have not improved with initial antibiotic therapy, patients with impaired host defenses, and patients with SIRS and hypotension.