Corticosteroids
Class Summary
Corticosteroids are used to alleviate local inflammation and accompanying pruritus or pain. Several topical steroids are available. Select the product according to the severity and location of the lesions. Triamcinolone is discussed only as a prototype.
Systemic steroids are used for the treatment of severe hypersensitivity reactions. They have anti-inflammatory effects and modify the immunologic responses. Exercise caution because of their metabolic effects. Prednisone is discussed as a prototype.
Triamcinolone topical (Aristocort)
Triamcinolone topical treats inflammatory dermatoses responsive to steroids. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.
Prednisone (Deltasone)
Prednisone has anti-inflammatory properties. It must be metabolized to the active metabolite prednisolone for effect, and thus, its conversion may be impaired in liver disease.
Antibiotics
Class Summary
Antibiotics are used for the prevention of infection (eg, patient experienced a penetrating injury, foreign body was inoculated into the wound) or for the treatment of a clinically apparent infection.
Initially, a broad-spectrum antibiotic should be selected. Penicillin G was once the drug of choice; however, it has fallen out of favor because of inactivity against penicillinase-producing bacteria, including many strains of staphylococci. Ideally, antibiotics should be selected after establishing the sensitivity of the microorganism.
For mycobacterial infections, the antibiotic treatment may be lengthy.
Ceftriaxone (Rocephin)
Ceftriaxone is a third-generation cephalosporin with broad-spectrum gram-negative activity, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. It arrests bacterial growth by binding to one or more penicillin-binding proteins.
Rifampin (Rifadin, Rimactane)
Rifampin is used primarily for the treatment of tuberculosis. It inhibits DNA-dependent bacterial but not mammalian RNA polymerase. It may be effective against aquatic M marinum. Additional medications can include co-trimoxazole, alone or combined with minocycline, clarithromycin, doxycycline, and ethambutol. Minocycline, doxycycline, or tetracycline as single agents have been used successfully to treat localized M marinum infections.
Trimethoprim and sulfamethoxazole (Bactrim DS, Septra DS, Cotrim)
Trimethoprim and sulfamethoxazole inhibits bacterial growth by inhibiting the synthesis of dihydrofolic acid. The antibacterial activity of TMP-SMZ includes common urinary tract pathogens, except Pseudomonas aeruginosa. It has been found to be effective in some nontuberculotic mycobacterial infections.
Minocycline (Dynacin, Minocin)
Minocycline treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma. It has been found to be effective in some nontuberculotic mycobacterial infections.
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Mycobacterium marinum infection. Courtesy of the Department of Dermatology, UTMB at Galveston, Texas.
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Jellyfish stings. Courtesy of the Department of Dermatology, UTMB at Galveston, Texas.
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Erysipeloid. Courtesy of the Department of Dermatology, UTMB at Galveston, Texas.
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Envenomation caused by Portuguese-man-of-war. Courtesy of the Department of Dermatology, UTMB at Galveston, Texas.
