Ecthyma Gangrenosum Medication

Updated: Oct 02, 2020
  • Author: Mina Yassaee Kingsbery, MD; Chief Editor: Dirk M Elston, MD  more...
  • Print

Medication Summary

Treatment of ecthyma gangrenosum (EG) requires the use of antipseudomonal penicillins, aminoglycosides, fluoroquinolones, third-generation cephalosporins, or aztreonam. Initially, antipseudomonal penicillin (piperacillin) is used in conjunction with an aminoglycoside (gentamicin). Further adjustment of antibiotics may be required after sensitivity results are known.



Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Antibiotic selection should be guided by blood culture sensitivity whenever feasible.

Piperacillin (Pipracil)

Piperacillin is a broad-spectrum penicillin. It inhibits the biosynthesis of cell wall mucopeptides and the stage of active multiplication. It has antipseudomonal activity.

Gentamicin (Gentacidin, Garamycin)

Gentamicin is an aminoglycoside antibiotic for gram-negative coverage. It is used in combination with both an agent against gram-positive organisms and one that covers anaerobes. Gentamicin is not the drug of choice. Consider it if penicillins or other less toxic drugs are contraindicated, when clinically indicated, and in mixed infections caused by susceptible staphylococci and gram-negative organisms.

Dosing regimens are numerous; adjust the dose based on CrCl and changes in the volume of distribution. Gentamicin may be given IV/IM.

Ciprofloxacin (Cipro)

Ciprofloxacin inhibits bacterial DNA synthesis and, consequently, growth. It is a fluoroquinolone with activity against pseudomonads, streptococci, MRSA, Staphylococcus epidermidis, and most gram-negative organisms, but no activity against anaerobes. Continue treatment for at least 2 days (7-14 d typical) after signs and symptoms have disappeared.

Ceftazidime (Fortaz, Ceptaz)

Ceftazidime is a third-generation cephalosporin with broad-spectrum, gram-negative activity; it has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. Ceftazidime arrests bacterial growth by binding to one or more penicillin-binding proteins.