Medical Care
Oral antibiotics are used to treat ecthyma. Hygiene is also important. Maintain cleanliness by using bactericidal soap and frequently changing bed linens, towels, and clothing. Remove ecthyma crusts by soaking or using wet compresses. Lesions should then be covered with petroleum jelly or mupirocin ointment. [9]
Oral penicillin is the standard of care for documented streptococcal ecthyma. Typically, a 7-day course is adequate. [10] If concomitant or primary S aureus infection is suspected, oral dicloxacillin and cephalexin are recommended as isolates are typically methicillin-susceptible. [10] Of interest, a 1971 study by Kelly et al demonstrated benzathine penicillin G eradication of streptococci and clinical healing of ecthyma lesions despite the concomitant presence of staphylococci. [1] If methicillin-resistant S aureus is isolated or suspected, doxycycline, clindamycin, and sulfamethoxazole-trimethoprim are therapeutic options. [10] Consider parenteral antibiotics for widespread ecthyma and in the setting of community outbreaks of poststreptococcal glomerulonephritis. [10]
Additional FDA-approved antibiotics for the treatment of acute bacterial skin and skin structure infections include oritavancin (Orbactiv), dalbavancin (Dalvance), and tedizolid (Sivextro). These agents are active against Staphylococcus aureus (including methicillin-susceptible and methicillin-resistant S aureus [MSSA, MRSA] isolates), Streptococcus pyogenes, Streptococcus agalactiae, and Streptococcus anginosus group (includes Streptococcus anginosus, Streptococcus intermedius, and Streptococcus constellatus), among others. For complete drug information, including dosing, see the following monographs:
Surgical Care
Gently debride ecthyma crusts.
Prevention
Maintaining cleanliness is critical for preventing ecthyma. Using insect repellants to prevent bites also may decrease the prevalence of ecthyma.
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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.
