dermatologic disorders
Erysipelas
Treatment of Erysipelas
Oral or parenteral antibiotics for erysipelas include one the following ( Treatment reference ): Penicillin V500 mg every 6 hours Amoxicillin875 mg every 12 hours Cephalexin500 mg every 6 hours Cefadroxil500 mg every 12 hours or 1 g once a day The 1st-lineparenteral antibiotic(for severe cases) is parenteral aqueous crystallinepenicillin G4 million units IV every 4 hours. Alternative parenteral antibiotics areceftriaxone1 to 2 g IV once a day andcefazolin1 to 2 g IV every 8 hours. Duration of treatment is based mainly on clinical response rather than a fixed interval. In Europe, pristinamycin and roxithromycin have been shown to be good choices for erysipelas. MRSA is not common among patients with erysipelas, and adding antibiotics to cover MRSA adds limited additional benefit. However, if MRSA is identified through culture or if MRSA is strongly suspected, an appropriate antibiotic such asclindamycin, sulfamethoxazole/trimethoprim,doxycycline,linezolid, orvancomycincan be added. For methicillin-sensitiveS. aureusinfections,dicloxacillinmay be used. Bed rest and leg elevation are helpful for leg erysipelas. Cold packs and analgesics may relieve local discomfort. Fungal foot infections may be an entry site for infection and may require antifungal treatment to prevent recurrence. Compression therapy (using, for example, Unna boots and compression socks) may also be of benefit for lower-extremity erysipelas. 1.Brindle R, Williams OM, Barton E, Featherstone P: Assessment of antibiotic treatment of cellulitis and erysipelas: A systematic review and meta-analysis.JAMA Dermatol155(9):1033–1040, 2019. doi: 10.1001/jamadermatol.2019.0884 