Soft Tissue Infections in the Emergency Department: The Case for the Use of ‘Simple’ Antibiotics

Abstract

Cellulitis, infected wounds, abscesses, and other bacterial infections of skin and soft tissue are commonly seen in the practice of emergency medicine. Informal observations in a teaching hospital suggest that newer agents having a broader antibiotic spectrum are frequently used for empiric outpatient treatment of mild to moderate soft tissue infections, so information from a prospective study was analyzed to determine whether this practice is appropriate. Healthy adult volunteers were enrolled in a study of the aerobic bacteriology and response to treatment of skin and soft tissue infections. Patients were randomized to receive a 10-day regimen of cephalexin (500 mg bid or qid) or ofloxacin (300 or 400 mg bid). Clinical response was assessed on two follow-up visits. Of 72 patients enrolled, 45 (63%) had cultures positive for pathogens. Cultures in 31 patients (43%) were positive for Staphylococcus aureus, five (7%) grew gram-negative rods, and five (7%) grew streptococcal species. Clinical response rates exceeded 95% in both the cephalexin- and ofloxacin-treated patients. Pathogens isolated from skin and soft tissue infections treated in the emergency department are not exotic or multiply resistant. The bacteriologic profile and clinical course of uncomplicated soft tissue infections indicate that treatment with a "simple" antibiotic, such as cephalexin, will result in resolution of the infection in nearly all cases. Broader spectrum antibiotics are not required for initial treatment of soft tissue infections in the emergency department.