Erysipelas in Emergency Medicine Medication

  • Author: Geofrey Nochimson, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 14, 2011
 

Medication Summary

Antibiotics should be started as soon as possible. In addition, antipyretic and analgesics may help alleviate symptoms.

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Antibiotics

Class Summary

Therapy must cover all likely pathogens in the context of the clinical setting.

Penicillin G (Pfizerpen)

 

Interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible microorganisms, including streptococci. DOC as streptococcal resistance very rarely has been reported in those strains likely to cause erysipelas. Resistance not yet observed in group A strains.

Erythromycin (EES, E-Mycin, Ery-Tab)

 

Inhibits RNA-dependent protein synthesis, possibly by stimulating the dissociation of peptidyl t-RNA from ribosomes; arrests bacterial growth.

Indicated to treat infections caused by streptococci in penicillin-allergic patients.

Penicillin VK (Veetids)

 

Used in mild cases. It inhibits biosynthesis of cell wall mucopeptides and is effective during the stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.

Cephalexin (Keflex, Biocef)

 

First-generation cephalosporin that inhibits bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal and effective against rapidly growing organisms forming cell walls.

Acceptable alternative to penicillin and may be useful in patients with minor penicillin allergies.

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Analgesics-antipyretics

Class Summary

Pain control is essential to quality patient care. These drugs ensure patient comfort, promote pulmonary toilet, and have sedating properties beneficial to patients who have sustained trauma or who experience pain.

Acetaminophen (Tylenol, Panadol, Aspirin Free Anacin)

 

DOC for treating pain in patients with documented hypersensitivity to aspirin or other NSAIDs, who are diagnosed with upper GI disease, or who take oral anticoagulants.

Codeine/acetaminophen (Tylenol 3)

 

For treatment of mild to moderate pain.

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

 

For relief of moderate to severe pain.

Oxycodone and acetaminophen (Percocet)

 

For relief of moderate to severe pain. DOC for aspirin-hypersensitive patients.

Aspirin (Anacin, Ascriptin, Bayer Aspirin)

 

Blocks prostaglandin synthetase action, which in turn inhibits prostaglandin synthesis and prevents formation of platelet-aggregating thromboxane A2; acts on hypothalamic heat-regulating center to reduce fever.

Ibuprofen (Ibuprin, Advil, Motrin)

 

Usually the DOC for treating mild to moderate pain, if no contraindications exist. One of the few NSAIDs indicated for reduction of fever.

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Contributor Information and Disclosures
Author

Geofrey Nochimson, MD  Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital

Geofrey Nochimson, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francis Counselman, MD  Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Eddy S Lang, MDCM, CCFP(EM), CSPQ  Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary; Assistant Professor, Department of Family Medicine, McGill University

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References
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  15. Swartz MN. Erysipelas. In: Mandell GL, ed, et al. Principles and Practice of Infectious Diseases. 4th ed. Churchill Livingstone; 1995:913-14.

  16. Torok L. Uncommon manifestations of erysipelas. Clin Dermatol. Sep-Oct 2005;23(5):515-8. [Medline].

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Facial erysipelas exhibiting classic fiery-red plaque with raised, well-demarcated borders.
 
 
 
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