What is the recommended treatment for Erysipelas?

From the Guidelines

The recommended treatment for Erysipelas is oral antibiotics targeting streptococci, primarily penicillin or amoxicillin, as stated in the 2018 WSES/SIS-E consensus conference recommendations 1.

Key Considerations

• For adults, typical dosing is amoxicillin 500mg three times daily for 5-10 days, or penicillin V 500mg four times daily for the same duration.
• For penicillin-allergic patients, clindamycin 300-450mg four times daily or azithromycin 500mg on day one followed by 250mg daily for four more days are appropriate alternatives, as suggested by the 2014 IDSA practice guidelines 1.
• In severe cases with systemic symptoms, initial intravenous therapy may be necessary using benzylpenicillin 1.2g every 6 hours or ceftriaxone 1-2g daily until improvement, then switching to oral therapy.

Additional Measures

• Patients should elevate the affected limb to reduce swelling, take analgesics for pain relief, and ensure adequate hydration.
• Cool compresses may help with discomfort.
• Treatment works by targeting the causative bacteria, primarily Group A streptococci, which invade the superficial dermis and lymphatics causing the characteristic well-demarcated, raised, erythematous skin lesion.

Expected Outcomes

• Most patients show improvement within 48-72 hours of starting antibiotics, but complete resolution of skin changes may take 7-10 days.
• It is essential to note that the 2018 WSES/SIS-E consensus conference recommendations 1 prioritize the use of antibiotics against Gram-positive bacteria, including streptococci, for the management of erysipelas.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION The dosage of penicillin V potassium tablets should be determined according to the sensitivity of the causative microorganisms and the severity of infection, and adjusted to the clinical response of the patient The usual dosage recommendations for adults and children 12 years and over are as follows: Streptococcal Infections Mild to moderately severe - of the upper respiratory tract and including scarlet fever and erysipelas: 125 to 250 mg (200,000 to 400,000 units) every 6 to 8 hours for 10 days

The recommended treatment for Erysipelas is penicillin V (PO) with a dosage of 125 to 250 mg (200,000 to 400,000 units) every 6 to 8 hours for 10 days 2.

• Key points:
  • The dosage is determined by the severity of infection and the sensitivity of the causative microorganisms.
  • The treatment should be adjusted according to the clinical response of the patient.

From the Research

Treatment of Erysipelas

The recommended treatment for erysipelas includes:

• Antibiotics, with penicillin being the drug of choice 3, 4
• Alternative antibiotics such as amoxicillin and macrolides may also be effective 3
• Bed rest with the leg elevated is also important 3
• Anticoagulants are indicated in patients at risk of venous thromboembolism 3
• Treatment of the portal of entry, such as athlete's foot, is also necessary 3

Antibiotic Prophylaxis

Antibiotic prophylaxis may be considered in patients with recurrent erysipelas, especially those with underlying conditions such as venous insufficiency or lymphatic congestion 5, 6

• Daily antibiotic prophylaxis may reduce the risk of recurrence, but the effect is not dramatic 6
• The choice of antibiotic for prophylaxis should be based on the causative microorganism and the patient's susceptibility to antibiotics 5

Comparison of Antibiotics

Comparative studies have shown that:

• Roxithromycin is as effective as penicillin in the treatment of erysipelas 7
• Penicillin is still the most commonly used antibiotic for erysipelas, but other antibiotics such as amoxicillin and macrolides may be used as alternatives 3, 4