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Deciding Between Oral Therapy and IV Antibiotics in Skin Infections

Is it better for patients presenting to the ED with nonpurulent skin and soft tissue infections (SSTI) to receive IV antibiotics, or will oral therapy suffice? Because guideline recommendations are unclear, researchers sought more information.

Investigators conducted a health records review of 500 adults with nonpurulent SSTIs treated at two tertiary care EDs. The goal was to determine how often oral antibiotic treatment failed, defined as either/or hospitalization, change in class of oral antibiotic, or switch to IV therapy after a minimum of 48 hours of oral therapy due to worsening infection.

Of 288 patients who had received a minimum of 48 hours of oral antibiotics, treatment failure occurred in 85 patients. Independently associated with oral antibiotic treatment failure were tachypnea at triage, chronic ulcers, history of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection, and cellulitis in the past 12 months.

The study authors recommended emergency clinicians consider these four factors when crafting treatment and management strategies.