Medication Summary

The best treatment for a gram-negative toe infection is often a combined approach by using both antibacterial agents and antifungal agents; sometimes, astringents are used.^[30]Debridement may be of value. Drying of the interdigital spaces is paramount. Sertaconazole nitrate cream 2% or any comparable azole or allylamine is beneficial the treatment of tinea pedis interdigitalis.^[31]

Class Summary

The mechanism of action may involve increasing the permeability of the cell membrane, which, in turn, causes intracellular components to leak.

Econazole topical (Ecoza)

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Econazole nitrate cream is an antifungal agent that is a water-miscible base consisting of pegoxol 7 stearate, peglicol 5 oleate, mineral oil, benzoic acid, butylated hydroxyanisole, and purified water. The color of the soft cream is white to off white, and it is for topical use only. It exhibits broad-spectrum activity against many gram-negative organisms. Econazole nitrate cream 1% is supplied in tubes of 15 g, 30 g, and 85 g.

Class Summary

Therapy must cover all likely pathogens in the context of the clinical setting.

Cefotaxime (Claforan)

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This is a third-generation semisynthetic broad-based antibiotic with a gram-negative spectrum. It has lower efficacy against gram-positive organisms. Specimens for bacteriologic culture should be obtained prior to therapy to test for susceptibilities to cefotaxime.

Ciprofloxacin (Cipro)

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Ciprofloxacin is a synthetic broad-spectrum antimicrobial agent that inhibits bacterial DNA synthesis and, consequently, growth. The film-coated tablet is available in 100 mg, 250 mg, 500 mg, and 750 mg. The oral suspension is white to slightly yellow with a strawberry flavor and may contain yellow-orange droplets. Tablets are well absorbed in the gastrointestinal tract after oral administration. Ciprofloxacin has a wide range of activity against gram-negative organisms.

Gentamicin sulfate (G-Myticin, Jenamicin, Garamycin)

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Gentamicin sulfate is a wide-spectrum antibiotic that provides highly effective topical treatment in primary and secondary bacterial infections of the skin. Gentamicin sulfate may clear infections that have not responded to other topical antibiotic agents. It treats superinfections caused by fungi or viruses. It treats skin and skin structure infections. The usual duration of treatment is 7-10 days. In more serious infections, a longer course of therapy is needed. Patients should be well hydrated during treatment. Gentamicin sulfate may also be used parenterally as a water-soluble injection against a wide variety of pathogenic bacteria. It may be considered as initial therapy in suggested or confirmed gram-negative infections, and therapy may be instituted before obtaining results of susceptibility testing.

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Media Gallery

A 33-year-old man with interweb exudative patches. Courtesy of Rajendra Kapila, MD, Professor of Infectious Diseases, New Jersey Medical School.

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Takeji Nishikawa, MD Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Dr. Frantisek Vosmik, and Jarrett R. Hesselbirg, MD, to the development and writing of this article.