The cellulitis season is open

F or some infectious diseases specialists, the equivalent of the summer blockbuster was the release of the 'Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections' (SSTI) update on June 18, 2014, by the Infectious Diseases Society of America (IDSA) (1). It is timely because summer is when patients consult the most for SSTI. In the present note, we review the most notable changes compared with the previous version published in 2005 (2). The new guidelines include a more structured and complete executive summary, and each section is organized around pertinent clinical questions. It is easier for the reader to rapidly identify the recommendations , which facilitate its use as a reference tool in day-today practice. It is a clear improvement compared with the 2005 version, which was mostly a hybrid between guidelines and a classical textbook approach. An effort to summarize and organize recommendations is also noted, with new algorithms and tables. Weighting of the quality of the evidence has been performed using the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). Various associations worldwide are increasingly adopting this system, mostly because it provides a way to rate quality of evidence and strength of recommendations that is explicit and comprehensive (3). This system is divided between strong and weak recommendations with different levels to rank the quality of evidence (very low, low, moderate and high), resulting in eight different categories of grading. Impetigo/echtyma Authors recommend performing a Gram stain and culture to differentiate Staphylococcus aureus from β-hemolytic streptococci (BHS) even if treatment is deemed reasonable without these studies (strong recommendation , moderate-quality evidence). Topical treatment with mupirocin or retapamulin twice daily for five days is recommended for all patients (strong recommendation, high-quality evidence), except those with numerous lesions or if they are part of an outbreak (to help decrease transmission). First-line suggested oral therapy consists of antistaphylococcal penicillins or first-generation cephalosporins (strong recommendation, moderate-quality evidence). If methicillin-resistant S aureus (MRSA) is suspected, or in patients allergic to penicillin , doxycycline, trimethoprim-sulfamethoxazole and clindamycin are acceptable options (strong recommendation, moderate quality evidence). The maximum suggested duration is seven days. Retapamulin 1% ointment was approved in Canada in 2008 and is now included in this update. This antimicrobial belongs to the pleuromutilin class and selectively inhibits bacterial protein synthesis through an interaction at the 50S subunit of the bacterial ribosome. Retapamulin is predominantly bacteriostatic against S …