Ecthyma Medication

  • Author: Loretta Davis, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 11, 2012
 

Medication Summary

The goals of pharmacotherapy for ecthyma are to reduce morbidity and to prevent complications.

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Antibiotics

Class Summary

Topical antibiotics should be considered adjunctive therapy in addition to systemic antibiotics for the treatment of ecthyma.

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Penicillin G benzathine (Bicillin LA)

 

DOC when a pyoderma is known to be caused by group A streptococci. Interferes with synthesis of cell wall mucopeptides during active multiplication, which results in bactericidal activity.

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Penicillin VK (Veetids, Beepen-VK)

 

Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.

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Erythromycin (E.E.S., E-Mycin, Ery-Tab)

 

Suitable alternative for patients who are allergic to penicillin. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections.

In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be taken q12h. For more severe infections, double the dose.

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Cephalexin (Keflex, Biocef)

 

First-generation cephalosporin arrests bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal activity against rapidly growing organisms. Primary activity against skin flora; used for skin infections or prophylaxis in minor procedures. Active against Streptococcus pyogenes and S aureus.

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Clindamycin (Cleocin)

 

Lincosamide for treatment of serious skin and soft tissue staphylococcal infections. Also effective against aerobic and anaerobic streptococci (except enterococci). Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

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Dicloxacillin (Dycill, Dynapen)

 

Treatment of infections caused by penicillinase-producing staphylococci. May use to initiate therapy when staphylococcal infection is suggested.

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Mupirocin (Bactroban)

 

Selectively binds to bacterial isoleucyl transfer-RNA synthetase, inhibiting protein synthesis.

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Contributor Information and Disclosures
Author

Loretta Davis, MD  Professor, Department of Internal Medicine, Division of Dermatology, Medical College of Georgia

Loretta Davis, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Donald Belsito, MD  Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center

Donald Belsito, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, New York County Medical Society, New York Dermatological Society, Noah Worcester Dermatological Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, and previous author, Carmen Mays, MD, to the development and writing of this article.

References

  1. [Best Evidence] Wasserzug O, Valinsky L, Klement E, et al. A cluster of ecthyma outbreaks caused by a single clone of invasive and highly infective Streptococcus pyogenes. Clin Infect Dis. May 1 2009;48(9):1213-9. [Medline].

  2. Ko WT, Adal KA, Tomecki KJ. Infectious diseases. Med Clin North Am. Sep 1998;82(5):1001-31, v. [Medline].

  3. Singh G. Heat, humidity and pyodermas. Dermatologica. 1973;147(5):342-7. [Medline].

  4. Allen AM, Taplin D, Twigg L. Cutaneous streptococcal infections in Vietnam. Arch Dermatol. Sep 1971;104(3):271-80. [Medline].

  5. Dagan R, Bar-David Y. Double-blind study comparing erythromycin and mupirocin for treatment of impetigo in children: implications of a high prevalence of erythromycin-resistant Staphylococcus aureus strains. Antimicrob Agents Chemother. Feb 1992;36(2):287-90. [Medline].

  6. Kelly C, Taplin D, Allen AM. Streptococcal ecthyma. Treatment with benzathine pencillin G. Arch Dermatol. Mar 1971;103(3):306-10. [Medline].

  7. Duve S, Voack C, Rakoski J, Hoffmann H. Extensive inguinal lymphadenitis. Ecthyma with inguinal lymphadenitis. Arch Dermatol. Jul 1996;132(7):823, 826. [Medline].

  8. Epstein ME, Amodio-Groton M, Sadick NS. Antimicrobial agents for the dermatologist. I. Beta-lactam antibiotics and related compounds. J Am Acad Dermatol. Aug 1997;37(2 Pt 1):149-65; quiz 166-8. [Medline].

  9. Hewitt WD, Farrar WE. Bacteremia and ecthyma caused by Streptococcus pyogenes in a patient with acquired immunodeficiency syndrome. Am J Med Sci. Jan 1988;295(1):52-4. [Medline].

  10. Leyden JJ, Kligman AM. Rationale for topical antibiotics. Cutis. Oct 1978;22(4):515-20, 522-8. [Medline].

  11. Peter G, Smith AL. Group A streptococcal infections of the skin and pharynx (first of two parts). N Engl J Med. Aug 11 1977;297(6):311-7. [Medline].

  12. Pichichero ME. Group A beta-hemolytic streptococcal infections. Pediatr Rev. Sep 1998;19(9):291-302. [Medline].

  13. Ray WA, Murray KT, Meredith S, Narasimhulu SS, Hall K, Stein CM. Oral erythromycin and the risk of sudden death from cardiac causes. N Engl J Med. Sep 9 2004;351(11):1089-96. [Medline].

  14. Sadick NS. Current aspects of bacterial infections of the skin. Dermatol Clin. Apr 1997;15(2):341-9. [Medline].

  15. Witkowski JA, Parish LC. Bacterial skin infections: management of common streptococcal and stapylococcal lesions. Postgrad Med. Oct 1982;72(4):166-8, 171-3, 176-8 passim. [Medline].

 
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