Vibrio species
Management of skin infections caused by Vibrio species includes incision, drainage and multiple debridements. For patients with severe infection and sepsis, aggressive surgical debridement or amputation may be required for source control.
Treat patients with risk factors for developing severe disease (eg liver disease, iron overload, immune compromise due to immunosuppressive medications, diabetes or malignancy) as if they have infection associated with systemic symptoms or involving deeper tissues even if infection is localised, because of the risk of fulminant infection.
Antibiotic therapy should be guided by antimicrobial susceptibility. Alternative regimens may be required—seek expert advice.
For localised infection not associated with systemic features or involving deeper tissues, for susceptible species, use:
1 doxycycline orally, 12-hourly1 wound infection, vibrio species doxycycline
adult: 100 mg
child 8 years or older and less than 26 kg: 50 mg
child 8 years or older and 26 to 35 kg: 75 mg
child 8 years or older and more than 35 kg: 100 mg
OR
2 ciprofloxacin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 12-hourly23. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment. wound infection, vibrio species ciprofloxacin
For patients with infection associated with systemic features or involving deeper tissues (such as bones, joints or tendons), and for patients with localised infection who have risk factors for severe disease, the appropriate regimen depends on whether oral therapy is appropriate. For patients with adequate oral absorption, for susceptible species, as a two-drug regimen, use:
1 ceftriaxone 2 g (child 1 month or older: 50 mg/kg up to 2 g) intravenously, 12-hourly wound infection, vibrio species ceftriaxone
OR
1 cefotaxime 2 g (child: 50 mg/kg up to 2 g) intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see cefotaxime dosage adjustment wound infection, water-immersed cefotaxime
PLUS with either of the above regimens
1 doxycycline orally, 12-hourly1 wound infection, vibrio species doxycycline
adult: 100 mg
child 8 years or older and less than 26 kg: 50 mg
child 8 years or older and 26 to 35 kg: 75 mg
child 8 years or older and more than 35 kg: 100 mg
OR
2 ciprofloxacin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 12-hourly23. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment. wound infection, vibrio species ciprofloxacin
Intravenous therapy must be used if oral absorption is likely to be impaired (eg following major trauma). For susceptible species, as a two-drug regimen, use:
1 ceftriaxone 2 g (child 1 month or older: 50 mg/kg up to 2 g) intravenously, 12-hourly wound infection, vibrio species ceftriaxone
OR
1 cefotaxime 2 g (child: 50 mg/kg up to 2 g) intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see cefotaxime dosage adjustment wound infection, water-immersed cefotaxime
PLUS with either of the above regimens
1 doxycycline 100 mg (child 8 years or older: 2 mg/kg up to 100 mg) intravenously, 12-hourly4 wound infection, vibrio species doxycycline
OR
2 ciprofloxacin 400 mg (child: 10 mg/kg up to 400 mg) intravenously, 12-hourly2. For dosage adjustment in adults with kidney impairment, see ciprofloxacin intravenous dosage adjustment. wound infection, vibrio species ciprofloxacin
The duration of treatment is determined by clinical response and whether deeper tissues are involved, and can exceed 2 weeks. Switch to oral therapy (as for localised infection, above) when the source of infection is controlled, clinical features have improved and oral antibiotics can be tolerated.