Erysipelas in Emergency Medicine Medication
- Author: Geofrey Nochimson, MD; Chief Editor: Rick Kulkarni, MD more...
Medication Summary
Antibiotics should be started as soon as possible. In addition, antipyretic and analgesics may help alleviate symptoms.
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.
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.
Bonnetblanc JM, Bedane C. Erysipelas: recognition and management. Am J Clin Dermatol. 2003;4(3):157-63. [Medline].
Pereira de Godoy JM, Galacini Massari P, Yoshino Rosinha M, et al. Epidemiological data and comorbidities of 428 patients hospitalized with erysipelas. Angiology. Jul 2010;61(5):492-4. [Medline].
Morris AD. Cellulitis and erysipelas. Clin Evid (Online). Jan 2 2008;2008:[Medline].
Bernard P. Management of common bacterial infections of the skin. Curr Opin Infect Dis. Apr 2008;21(2):122-8. [Medline].
Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. N Engl J Med. Jan 25 1996;334(4):240-5. [Medline].
Bratton RL, Nesse RE. St. Anthony's Fire: diagnosis and management of erysipelas. Am Fam Physician. Feb 1 1995;51(2):401-4. [Medline].
Chartier C, Grosshans E. Erysipelas. Int J Dermatol. Sep 1990;29(7):459-67. [Medline].
Elston DM. Epidemiology and prevention of skin and soft tissue infections. Cutis. May 2004;73(5 Suppl):3-7. [Medline].
Jorup-Ronstrom C, Britton S. Recurrent erysipelas: predisposing factors and costs of prophylaxis. Infection. Mar-Apr 1987;15(2):105-6. [Medline].
Krasagakis K, Samonis G, Maniatakis P, Georgala S, Tosca A. Bullous erysipelas: clinical presentation, staphylococcal involvement and methicillin resistance. Dermatology. 2006;212(1):31-5. [Medline].
Krasagakis K, Valachis A, Maniatakis P, et al. Analysis of epidemiology, clinical features and management of erysipelas. Int J Dermatol. Sep 2010;49(9):1012-7. [Medline].
Lopez FA, Lartchenko S. Skin and soft tissue infections. Infect Dis Clin North Am. Dec 2006;20(4):759-72, v-vi. [Medline].
Morris A. Cellulitis and erysipelas. Clin Evid. Jun 2006;2207-11. [Medline].
Pereira de Godoy JM, Galacini Massari P, Yoshino Rosinha M, et al. Epidemiological data and comorbidities of 428 patients hospitalized with erysipelas. Angiology. Jul 2010;61(5):492-4. [Medline].
Swartz MN. Erysipelas. In: Mandell GL, ed, et al. Principles and Practice of Infectious Diseases. 4th ed. Churchill Livingstone; 1995:913-14.
Torok L. Uncommon manifestations of erysipelas. Clin Dermatol. Sep-Oct 2005;23(5):515-8. [Medline].

