Complicated skin and soft tissue infection

Bacterial infection involving deeper skin structures and subcutaneous tissue: deep cellulitis, infected ulcers, postoperative wounds, diabetic foot with systemic features. Per IDSA 2014 and SEIMC 2023, with suspected MRSA use vancomycin, linezolid, daptomycin, or ceftaroline. Empiric therapy starts after cultures are taken; drain abscesses. With systemic response (SIRS, sepsis) – intravenous treatment in hospital.

ICD-10 L08.91 drug

Also known as: Complicated SSTI, cSSTI, Severe cellulitis, Necrotizing fasciitis (subset)

Drugs used for this condition

ADaptomycinSecond line · Cyclic lipopeptide antibioticComplicated skin and soft tissue infections in adults, including confirmed MRSA. Per IDSA 2014 and SEIMC 2023 – alternative to vancomycin in intolerance, with MRSA MIC ≥1.5 mg/L, or with no response to vancomycin at 72 hours. Dose: 4 mg/kg IV once daily for 7–14 days. With severe renal impairment (CrCl <30) extend interval to 48 hours. Use empirically only after cultures.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit