Medication Summary
The goals of pharmacotherapy for ecthyma are to reduce morbidity and to prevent complications.
Antibiotics
Class Summary
Topical antibiotics should be considered adjunctive therapy in addition to systemic antibiotics for the treatment of ecthyma.
Penicillin G benzathine (Bicillin LA)
Penicillin G benzathine is the drug of choice when a pyoderma is known to be caused by group A streptococci. It interferes with the synthesis of cell wall mucopeptides during active multiplication, which results in bactericidal activity.
Penicillin VK (Veetids, Beepen-VK)
Penicillin VK inhibits biosynthesis of cell wall mucopeptide and is effective during the stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.
Cephalexin (Keflex, Biocef)
Cephalexin is a first-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. It has bactericidal activity against rapidly growing organisms. Its primary activity is against skin flora; it is used for skin infections or prophylaxis in minor procedures. It is active against Streptococcus pyogenes and S aureus.
Dicloxacillin (Dycill, Dynapen)
Dicloxacillin is used for treatment of infections caused by penicillinase-producing staphylococci. It can be used to initiate therapy when staphylococcal infection is suggested.
Clindamycin (Cleocin)
Clindamycin is a lincosamide for the treatment of serious skin and soft-tissue staphylococcal infections. It is also effective against aerobic and anaerobic streptococci (except enterococci). It inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Trimethoprim/sulfamethoxazole (Bactrim, Bactrim DS, Cotrim)
This combination agent inhibits the biosynthesis of proteins and nucleic acids needed for bacterial growth. It typically is effective for methicillin-resistant S aureus.
Doxycycline (Doxycin, Acticlate, Adoxa)
Doxycycline inhibits bacterial growth by inhibiting protein synthesis. It often is effective for methicillin-resistant S aureus. It is not recommended for children younger than 8 years.
Mupirocin (Bactroban)
Mupirocin selectively binds to bacterial isoleucyl transfer-RNA synthetase, inhibiting protein synthesis.
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Typical ecthyma lesions of the lower extremities.
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The stages of ecthyma: the lesion begins as a pustule that later erodes and ultimately forms an ulcer with adherent crust.
