Suggested approach to initial antimicrobial therapy for suspected Staphylococcus aureus or streptococcal skin and soft tissue infections in infants ≤28 days of age

SSTI: skin and soft tissue infection; T: temperature; MRSA: methicillin-resistant S. aureus; GBS: group B Streptococcus; MSSA: methicillin-susceptible S. aureus.
* These regimens provide adequate empiric therapy for group B streptococcal cellulitis but are not appropriate for neonatal sepsis or meningitis. Refer to UpToDate content on treatment of neonatal sepsis and meningitis.
¶ Refer to UpToDate topics on SSTI in neonates for additional details, including duration of therapy.
Δ Should be avoided in neonates with hyperbilirubinemia and in neonates receiving calcium-containing intravenous fluids.
◊ We consider the local prevalence of MRSA to be high if >15% of S. aureus isolates are MRSA. Other experts may have a different threshold for increased prevalence of MRSA.
§ We do not use clindamycin if the local prevalence of clindamycin-resistant S. aureus is >15%. Other experts may have a different threshold for avoidance of clindamycin.
¥ Parenteral coverage should be broadened to include coverage for MRSA, GBS, and enteric gram-negative pathogens if the infant develops systemic findings and to include coverage for MRSA, GBS, and other beta-hemolytic streptococci if the infant develops cellulitis.