What is the recommended workup and treatment for ecthyma?

From the Guidelines

The recommended workup for ecthyma includes clinical examination and bacterial culture of the lesion to identify the causative organism, typically group A beta-hemolytic streptococci or Staphylococcus aureus, as recommended by the Infectious Diseases Society of America 1. The workup and treatment of ecthyma involve several key steps, including:

• Clinical examination to assess the severity and extent of the infection
• Bacterial culture of the lesion to identify the causative organism, which is typically group A beta-hemolytic streptococci or Staphylococcus aureus 1
• Gentle cleansing of the affected area with warm water and antibacterial soap, followed by removal of crusts and application of warm compresses
• Topical antibiotics such as mupirocin or retapamulin may be applied to the lesions, but oral antibiotics are usually necessary for ecthyma, with first-line options including dicloxacillin or cephalexin for 7 days, as recommended by the Infectious Diseases Society of America 1
• In cases of suspected MRSA, appropriate alternatives include doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) 1 The treatment efficacy is based on ecthyma's pathophysiology as a deeper skin infection that penetrates the dermis, requiring more aggressive antimicrobial therapy than superficial impetigo. Some key points to consider in the treatment of ecthyma include:
• The importance of covering the affected areas with sterile dressings to prevent spread of infection
• The need for good hygiene practices, including regular handwashing and avoiding sharing personal items, to prevent transmission
• The potential for systemic antimicrobials to be used for infections during outbreaks of poststreptococcal glomerulonephritis to help eliminate nephritogenic strains of S. pyogenes from the community 1

From the Research

Ecthyma Workup and Treatment

Ecthyma is a type of skin infection that can be caused by bacteria such as Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA) 2, 3, 4, 5. The workup and treatment of ecthyma typically involve:

• Obtaining a thorough medical history and performing a physical examination to assess the extent of the infection
• Obtaining a culture of the infected tissue to identify the causative organism and determine its antibiotic susceptibility 3, 5
• Initiating antibiotic therapy based on the results of the culture and susceptibility testing 2, 4
• Monitoring the patient's response to treatment and adjusting the antibiotic regimen as needed 6, 5

Antibiotic Treatment Options

The choice of antibiotic for the treatment of ecthyma depends on the severity of the infection, the causative organism, and the patient's medical history and allergies. Some common antibiotic treatment options for ecthyma include:

• Vancomycin, linezolid, and daptomycin for severe or complicated infections caused by MRSA 2, 4
• Clindamycin, trimethoprim-sulfamethoxazole, and doxycycline for less severe infections caused by MRSA or other bacteria 2, 3
• Cephalexin and other cephalosporins for infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) 3

Important Considerations

When working up and treating ecthyma, it is essential to consider the following:

• The increasing prevalence of antibiotic-resistant bacteria, such as MRSA, and the need for careful antibiotic stewardship 3, 6, 5
• The importance of obtaining a culture of the infected tissue to guide antibiotic therapy and ensure effective treatment 3, 5
• The need for close monitoring of the patient's response to treatment and adjustment of the antibiotic regimen as needed to ensure optimal outcomes 6, 5