The role of older antibiotics in the treatment of skin and soft tissue infections: current perspectives

PURPOSE OF REVIEW: The aim is to discuss the evidence and recent literature on the role of older antibiotics in the treatment of skin and soft tissue infections (SSTIs). RECENT FINDINGS: The choice of therapy for SSTIs is complicated in view of the rising antimicrobial resistance (AMR) and the availability of new antibiotics. SSTIs are predominantly caused by Staphylococcus aureus and beta-hemolytic streptococci, but other organisms can be involved in patients with comorbidities or post trauma. Treatment options are dictated by the accessibility and cost of newer antibiotics in resource-constrained settings. 'Old antibiotics' including β-lactams, doxycycline, trimethoprim-sulfamethoxazole (TMP/SMX), clindamycin, azithromycin, and ciprofloxacin remain good choices in treating SSTIs. They offer affordable options for outpatient settings. Only few randomized trials have addressed the role of the old agents in SSTIs treatment. Studies suggest that these agents remain effective for empirical and targeted therapy based on the epidemiological context. Ongoing surveillance and clinical trials are needed to assess the role of these agents and to integrate them into modern SSTIs management, supporting sustainable treatment models in both high-income and low-income settings. SUMMARY: Older antibiotics can be effectively used in treating SSTIs, provided their use is guided by current epidemiological data or culture and susceptibility results.