This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine (CJEM) that looks at the treatment of non-purulent skin and soft tissue infections (SSTIs) in the emergency department.1 Current practice patterns are highly variable between emergency physicians, with differences in the choice of antibiotic, duration of therapy, route of administration (oral or intravenous) and time to reassessment. Furthermore, the risk factors that predict the failure of oral antibiotics for SSTIs are poorly understood and require further investigation.
To answer these questions, a national survey of physician members of the Canadian Association of Emergency Physicians (CAEP) was conducted by Yadav et al.1 A 61-question survey was developed and used to characterize the practice patterns of emergency physicians and perceived risk factors in predicting failure with oral antibiotics for SSTIs. Based on the results of this survey, most emergency physicians preferred oral or IV cephalexin and cefazolin for treating SSTIs, as well as a 7-day duration for oral antibiotics. By contrast, there was a lack of consensus on the route of administration and time to reassessment. Emergency physicians also relied heavily on their clinical impression (97.4%) and patient comorbidities (87.7%) in their decision to start IV antibiotics. Perceived risk factors for oral treatment failure included crepitus, hypotension, severe pain, rapidly spreading erythema and issues with compliance.
Overall, this study highlights the lack of consensus on the management of non-purulent SSTIs and identified several perceived risk factors that could predict treatment failure with oral antibiotics. Future studies are needed to improve the physician approach to the management of SSTIs.