Medication Summary
Antibiotics should be started as soon as possible in patients with erysipelas. As previously stated, streptococci cause most cases of the disease; thus, penicillin has remained a first-line therapy. [17, 18] A first-generation cephalosporin or macrolide, such as erythromycin or azithromycin, may be used if the patient has an allergy to penicillin.
Antipyretics and analgesics may help to alleviate symptoms; these drugs ensure patient comfort and have sedating properties beneficial to patients who have sustained trauma or who experience pain.
Antibiotics
Class Summary
Penicillin is the standard therapy for typical erysipelas, although coverage for Staphylococcus aureus should be considered in the appropriate setting.
Penicillin VK
Penicillin G procaine (Wycillin) and penicillin VK (PenVeeK) are currently recommended as first-line agents for the treatment of moderately severe infections of skin and skin structure. In adults, administer penicillin G procaine by deep intramuscular injection only into upper, outer quadrant of buttock. In infants and small children, the midlateral aspect of the thigh may be a better site for administration.
Dicloxacillin
Dicloxacillin, used in the treatment of infections caused by penicillinase-producing staphylococci, is a penicillinase-resistant penicillin that will cover possible S aureus.
Nafcillin
Nafcillin is the initial therapy for suspected penicillin G ̶ resistant streptococcal or staphylococcal infections. Use parenteral therapy initially in severe infections, and change to oral therapy as the condition warrants.
Because nafcillin may cause thrombophlebitis at the injection site, particularly in elderly patients, administer parenterally only for a short term (1-2 d); change to oral administration as clinically indicated.
Cephalexin (Keflex)
Cephalexin is a first-generation cephalosporin that inhibits bacterial growth by inhibiting bacterial cell wall synthesis. This agent is bactericidal and is effective against rapidly growing organisms forming cell walls. Cephalexin is an acceptable alternative to penicillin and may be useful in patients with minor penicillin allergies.
Erythromycin (Ery-Tab, PCE, Erythrocin)
Erythromycin is a macrolide used for penicillin-allergic individuals. It inhibits bacterial growth, possibly by blocking dissociation of peptidyl transfer ribonucleic acid (t-RNA) from ribosomes, causing RNA-dependent protein synthesis to arrest. Erythromycin is administered for the treatment of staphylococcal and streptococcal infections.
In children, age, weight, and severity of infection determine proper dosage. When twice-daily dosing is desired, half of the total daily dose may be taken every 12 hours. For more severe infections, double the dose.
Azithromycin (Zithromax, Zmax)
Azithromycin acts by binding to the 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Nucleic acid synthesis is not affected.
Azithromycin concentrates in phagocytes and fibroblasts as demonstrated by in vitro incubation techniques. In vivo studies suggest that its concentration in phagocytes may contribute to drug distribution to inflamed tissues.
Azithromycin treats mild-to-moderate microbial infections. Plasma concentrations are very low, but tissue concentrations are much higher, giving it value in treating intracellular organisms. It has a long tissue half-life, which allows for once-daily dosing for skin and soft-tissue infections.
Clindamycin (Cleocin, Cleocin Pediatric, ClindaMax Vaginal)
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). Clindamycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Clostridium difficile-associated diarrhea is a potential adverse effect.
Analgesics-Antipyretics
Class Summary
Pain control is essential to quality patient care. Analgesics and antipyretics ensure patient comfort, promote pulmonary toilet, and have sedating properties beneficial to patients who have sustained trauma or who experience pain.
Acetaminophen (Tylenol, Aspirin Free Anacin, APAP 500, Acephen, FeverAll)
This is the drug of choice (DOC) for treating pain in patients with documented hypersensitivity to aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), who are diagnosed with upper gastrointestinal disease, or who take oral anticoagulants.
Codeine/acetaminophen (Tylenol with Codeine No. 3)
Codeine/acetaminophen is used for the treatment of mild to moderate pain.
Hydrocodone bitartrate and acetaminophen (Vicodin ES, Lortab, Zydone, Norco)
This combination is used for the relief of moderate to severe pain.
Oxycodone and acetaminophen (Percocet, Endocet, Roxicet, Magnacet)
The combination of oxycodone and acetaminophen is used for the relief of moderate to severe pain. It is the DOC for aspirin-hypersensitive patients.
Aspirin (Ascriptin Regular Strength, Bayer Aspirin, Aspirtab, Ecotrin)
Aspirin blocks prostaglandin synthetase action, which in turn inhibits prostaglandin synthesis and prevents the formation of platelet-aggregating thromboxane A2; it acts on the hypothalamic heat-regulating center to reduce fever.
Ibuprofen (Addaprin, Advil, Motrin, Caldolor, Dyspel)
Ibuprofen is usually the DOC for treating mild to moderate pain, if no contraindications exist. It is one of the few NSAIDs indicated for fever reduction.
Naproxen (Naprosyn, Aleve, Naprelan, Anaprox)
Naproxen is used for the relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing COX activity, which results in decreased prostaglandin synthesis.
Ketoprofen
Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are indicated initially in small patients, elderly patients, and patients with renal or liver disease. Doses higher than 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient's response.
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Well-demarcated, erythematous plaque of erysipelas. Courtesy of the US Centers for Disease Control and Prevention.
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Facial erysipelas exhibiting classic fiery-red plaque with raised, well-demarcated borders.
