Rationale:

• Oral therapy is adequate treatment for most mild, uncomplicated infections.

Evidence:

• The efficacy of cephalexin is equivalent to that of dicloxacillin in the treatment of children with skin infections caused by S. aureus (86).
• Patients treated with cephalexin should be observed for failure. In some studies a high failure rate has been observed for cephalexin compared with other β-lactam antibiotics in the treatment of uncomplicated outpatient cellulitis in adult patients (87). Such failures may result from poor absorption due to achlorhydria (33; 81).
• Cefuroxime is effective treatment of soft tissue infections associated with bacteremia in children (87).
• Oral linezolid is equivalent to intravenous oxacillin/oral dicloxacillin in adults with complicated soft tissue infections (88).
• Frequent recurrences have been prevented by long-term administration of prophylactic antibiotics (89). In patients with chronic lymphedema, selenium has been effective in one study in preventing recurrences (90).

Comments:

• Because of its cost, linezolid should only be used for moderate to severe MRSA infection.
• Use of gatifloxacin is contraindicated in diabetic patients due to the higher risk of hyperglycemia and hypoglycemia, and should be used cautiously in older patients and those with renal insufficiency.