It has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. Gino M, Empiric antibiotic regimen should include an agent active against Coverage for aerobic gram-negative pathogens is required for severe infection, chronic infection, or infection that fails to respond to recent antibiotic therapyNecrotic, gangrenous, or foul-smelling wounds usually require antianaerobic therapyInitial empiric antibiotic therapy should be modified on the basis of the clinical response and culture or susceptibility testingCoverage for less virulent organisms, such as coagulase-negative staphylococci, may not be neededParenteral antibiotics are indicated for patients who are systemically ill, have severe infection, are unable to tolerate oral agents, or have infection caused by pathogens that are not susceptible to oral agentsUsing oral antibiotics for mild to moderate infection and switching early from parenteral to oral antibiotics with appropriate spectrum coverage and good bioavailability and tolerability are strongly encouragedAlthough topical antibiotics can be effective for the treatment of mildly infected ulcers, they should not be routinely usedDiscontinuation of antibiotics should be considered when all signs and symptoms of infection have resolved, even if the wound has not completely healedCost should be considered when selecting antibiotic therapyEmpiric antibiotic regimen should include an agent active against Coverage for aerobic gram-negative pathogens is required for severe infection, chronic infection, or infection that fails to respond to recent antibiotic therapyNecrotic, gangrenous, or foul-smelling wounds usually require antianaerobic therapyInitial empiric antibiotic therapy should be modified on the basis of the clinical response and culture or susceptibility testingCoverage for less virulent organisms, such as coagulase-negative staphylococci, may not be neededParenteral antibiotics are indicated for patients who are systemically ill, have severe infection, are unable to tolerate oral agents, or have infection caused by pathogens that are not susceptible to oral agentsUsing oral antibiotics for mild to moderate infection and switching early from parenteral to oral antibiotics with appropriate spectrum coverage and good bioavailability and tolerability are strongly encouragedAlthough topical antibiotics can be effective for the treatment of mildly infected ulcers, they should not be routinely usedDiscontinuation of antibiotics should be considered when all signs and symptoms of infection have resolved, even if the wound has not completely healedCost should be considered when selecting antibiotic therapyCephalexin (Keflex) 500 mg orally four times per dayFor penicillin-allergic patients, except those with immediate hypersensitivity reactionsAmoxicillin/clavulanate (Augmentin) 875/125 mg orally twice per dayClindamycin (Cleocin) 300 to 450 mg orally three times per dayPotential cross-resistance and emergence of resistance in erythromycin-resistant Doxycycline (Vibramycin) 100 mg orally twice per dayModerate (duration of treatment is two to four weeks, depending on response; administer orally or parenterally followed by orally)Ampicillin/sulbactam (Unasyn) 3 g IV four times per dayCeftriaxone (Rocephin) 1 to 2 g IV once per day plus clindamycin 600 to 900 mg IV or orally three times per day or metronidazole (Flagyl) 500 mg IV or orally three times per dayLevofloxacin (Levaquin) 500 mg IV or orally once per day plus clindamycin 600 to 900 mg IV or orally three times per dayMoxifloxacin (Avelox) 400 mg IV or orally once per daySevere (duration of treatment is two to four weeks, depending on response; administer parenterally, then switch to orally)Ciprofloxacin (Cipro) 400 mg IV twice per day plus clindamycin 600 to 900 mg IV three times per dayPiperacillin/tazobactam (Zosyn) 3.375 to 4.500 g IV every six to eight hoursImipenem/cilastatin (Primaxin) 500 mg IV four times per dayVancomycin 30 mg per kg IV twice per day plus ciprofloxacin 400 mg IV twice per day plus metronidazole 500 mg IV or orally three times per dayVancomycin is the parenteral drug of choice for MRSA; linezolid (Zyvox) 600 mg IV or orally twice per day or daptomycin (Cubicin) 4 mg per kg IV once per day can also be used for MRSATigecycline (Tygacil) 100 mg IV loading dose then 50 mg IV twice per dayShould be used when suspected polymicrobial infection, including MRSAUse the above parenteral or oral antibiotic regimens for two to five daysUse the above parenteral or oral antibiotic regimens for two to four weeksInitially use the above parenteral antibiotics followed by oral antibiotics for four to six weeksInitially use the above parenteral antibiotics followed by oral antibiotics for eight to 12 weeksCephalexin (Keflex) 500 mg orally four times per dayFor penicillin-allergic patients, except those with immediate hypersensitivity reactionsAmoxicillin/clavulanate (Augmentin) 875/125 mg orally twice per dayClindamycin (Cleocin) 300 to 450 mg orally three times per dayPotential cross-resistance and emergence of resistance in erythromycin-resistant Doxycycline (Vibramycin) 100 mg orally twice per dayModerate (duration of treatment is two to four weeks, depending on response; administer orally or parenterally followed by orally)Ampicillin/sulbactam (Unasyn) 3 g IV four times per dayCeftriaxone (Rocephin) 1 to 2 g IV once per day plus clindamycin 600 to 900 mg IV or orally three times per day or metronidazole (Flagyl) 500 mg IV or orally three times per dayLevofloxacin (Levaquin) 500 mg IV or orally once per day plus clindamycin 600 to 900 mg IV or orally three times per dayMoxifloxacin (Avelox) 400 mg IV or orally once per daySevere (duration of treatment is two to four weeks, depending on response; administer parenterally, then switch to orally)Ciprofloxacin (Cipro) 400 mg IV twice per day plus clindamycin 600 to 900 mg IV three times per dayPiperacillin/tazobactam (Zosyn) 3.375 to 4.500 g IV every six to eight hoursImipenem/cilastatin (Primaxin) 500 mg IV four times per dayVancomycin 30 mg per kg IV twice per day plus ciprofloxacin 400 mg IV twice per day plus metronidazole 500 mg IV or orally three times per dayVancomycin is the parenteral drug of choice for MRSA; linezolid (Zyvox) 600 mg IV or orally twice per day or daptomycin (Cubicin) 4 mg per kg IV once per day can also be used for MRSATigecycline (Tygacil) 100 mg IV loading dose then 50 mg IV twice per dayShould be used when suspected polymicrobial infection, including MRSAUse the above parenteral or oral antibiotic regimens for two to five daysUse the above parenteral or oral antibiotic regimens for two to four weeksInitially use the above parenteral antibiotics followed by oral antibiotics for four to six weeksInitially use the above parenteral antibiotics followed by oral antibiotics for eight to 12 weeksThe patient should be reassessed 24 to 72 hours after initiating empiric antibiotic therapy to evaluate the response and to modify the antibiotic regimen, if indicated by early culture results.