From the Guidelines
Erysipelas should be treated with penicillin (500 mg qid) or amoxicillin (500 mg 3 times daily [tid]) for 7–10 days, as recommended by the Infectious Diseases Society of America 1. This approach is based on the strongest and most recent evidence available, which prioritizes the use of these antibiotics for the treatment of erysipeloid, a condition closely related to erysipelas.
Key Considerations
- The treatment of erysipelas involves the use of antibiotics to manage the bacterial infection, with penicillin being the first-line therapy.
- The dosage and duration of antibiotic treatment are crucial, with penicillin V 500mg orally four times daily or amoxicillin 500mg three times daily for 7-10 days being the recommended regimen 1.
- For patients allergic to penicillin, alternative antibiotics such as clindamycin or macrolides like azithromycin may be used.
- Severe cases of erysipelas may require intravenous antibiotics, and patients should be advised to elevate the affected limb, apply cool compresses, and take analgesics as needed.
Management and Prevention
- Erysipelas can be differentiated from cellulitis by its raised borders and more superficial involvement, although both conditions are treated similarly.
- Recurrent episodes of erysipelas may require prophylactic antibiotics and addressing predisposing factors such as tinea pedis, venous insufficiency, or lymphedema.
- Without proper treatment, erysipelas can lead to complications including abscess formation, necrotizing fasciitis, or bacteremia, emphasizing the importance of prompt and effective antibiotic therapy 1.
From the Research
Definition and Causes of Erysipelas
- Erysipelas is an acute bacterial infection of the dermis and hypodermis, associated with clinical inflammation 2.
- It is generally caused by group A streptococci, with streptococcal toxins also playing a role in the clinical inflammation 2.
- The face, arm, upper thigh, and leg are common sites for the occurrence of erysipelas, with the leg being the most common site 2, 3.
Clinical Presentation and Diagnosis
- Erysipelas is characterized by a sudden onset of areas of erythema and edema with well-defined margins 2.
- It is often associated with high fever, adenopathy, and lymphangitis 2.
- The diagnosis of erysipelas is made clinically, with laboratory tests not usually required 2, 4.
- Differential diagnoses include necrotizing cellulitis, fasciitis, and other non-infectious types of cellulitis 2.
Treatment and Management
- Penicillin G is usually effective in treating erysipelas, with amoxicillin and macrolides also being effective options 2, 5.
- Bed rest with the leg elevated, anticoagulants for patients at risk of venous thromboembolism, and treatment of the portal of entry are also important aspects of management 2, 4.
- Long-term antibacterial therapy may be required for patients with recurrence 2, 5.
- A network meta-analysis of randomized controlled trials found that pristinamycin showed the most promising results in achieving cure rates for erysipelas, but with a higher risk of rash 6.
Complications and Prevention
- Recurrence is a common complication of erysipelas, with abscesses and septicemia being rare complications 2.
- Prevention of recurrence involves long-term therapy of lymphoedema and consistent avoidance and treatment of entry sites 4.
- Athlete's foot is a common portal of entry for the disease, highlighting the importance of foot care in preventing erysipelas 2.