You are managing an otherwise healthy patient with cellulitis but no abscess to poke. You decide this patient needs antibiotics but is stable enough to go home.

“Give em’ a dose of vanc before they go,” right?

Here is why giving one-dose vancomycin for SSTIs in stable patients is a bad idea:

• NO evidence that this shows any benefit.
• Not recommended by the Infectious Diseases Society of America (IDSA)¹
• Extends the patient’s ED stay by at least an hour for the IV infusion
• Increases the cost of the ED visit (IV line, medication, RN time)
• Pharmacokinetically 1 dose of vancomycin makes no sense for SSTIs
  • – 1 gm IV x 1 is sub-therapeutic for decent adult kidneys
  • – Effective bug-killing is based on drug levels achieved with repeated dosing over several days
• Subtherapeutic vancomycin concern in the age of multi-drug resistant (MDR) organisms
  • Check out this 2009 editorial in the New England Journal of Medicine on antibiotic-resistant bugs in the 21st century.

Here is how I approach consults for uncomplicated SSTI antibiotics:

Some will argue that we should still give SSTI patients one dose of IV antibiotics and send them out on the same PO antibiotics – i.e. clindamycin. Remember that infusion time for IV antibiotics is usually 30-60 minutes, the same time it takes for the antibiotics to be absorbed from the GI tract, so giving 1 dose of IV antibiotics as a “load” before discharge is not necessary.

Oral antibiotics commonly used for SSTIs and their bioavailability (source – package inserts):

• Clindamycin ~90%
• Sulfamethoxazole/Trimethoprim ~100%
• Doxycycline ~100%
• Linezolid ~100%

Would love your feedback!

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