What is the treatment for Erysipelas (acute bacterial infection of the upper dermis)?

From the Guidelines

Erysipelas is typically treated with antibiotics targeting Group A Streptococcus, the most common causative organism, with oral penicillin V (500 mg four times daily for 7-10 days) or amoxicillin (500 mg three times daily for 7-10 days) being the first-line treatment, as recommended by the Infectious Diseases Society of America in 2014 1. The treatment approach for erysipelas involves:

• Oral antibiotics for mild to moderate cases, with penicillin V or amoxicillin being the preferred choices
• Alternative antibiotics such as clindamycin or macrolides for patients with penicillin allergies
• Intravenous antibiotics such as penicillin G or ceftriaxone for severe cases
• Supportive measures including elevation of the affected area, cool compresses, and over-the-counter pain relievers The Infectious Diseases Society of America recommends penicillin (500 mg four times daily) or amoxicillin (500 mg three times daily) for 7-10 days for the treatment of erysipeloid, which is a similar condition to erysipelas, caused by Erysipelothrix rhusiopathiae 1. It is essential to note that erysipelas can recur in some patients, particularly those with predisposing factors like lymphedema, so addressing underlying conditions is crucial for prevention, as highlighted in the guidelines for the diagnosis and management of skin and soft tissue infections 1.

From the FDA Drug Label

Erythromycin tablets are indicated in the treatment of infections caused by susceptible strains of the designated microorganisms in the diseases listed below: Skin and skin structure infections of mild to moderate severity caused by Streptococcus pyogenes or Staphylococcus aureus

The treatment for Erysipelas, an acute bacterial infection of the upper dermis, is erythromycin for infections caused by susceptible strains of Streptococcus pyogenes or Staphylococcus aureus 2.

• Key points:
  • Erysipelas is typically caused by Streptococcus pyogenes.
  • Erythromycin is effective against Streptococcus pyogenes.
  • The drug label indicates erythromycin is used for skin and skin structure infections of mild to moderate severity caused by Streptococcus pyogenes.

From the Research

Treatment Overview

• The treatment of erysipelas typically involves antibiotics, with the goal of eliminating the bacterial infection [(3,4,5,6,7)].
• The most commonly recommended antibiotic is penicillin, specifically group G penicillin 3 or penicillin G [(4,7)].

Antibiotic Regimens

• First-line treatment options include:
  • Group G penicillin (80%) 3
  • Amino-penicillins (11%) 3
  • Cephalosporins (16.5%) 3
  • Anti-staphylococcal penicillins (6.9%) 3
• Second-line treatment options include:
  • Macrolides (63.5%) 3
  • Clindamycin (52.5%) [(3,5)]
  • Penicillins (18.5%) 3
  • Cephalosporins (40%) 3
  • Fluoroquinolones (20.5%) 3

Additional Treatment Measures

• Adjuvant measures may include:
  • Anticoagulation [(3,4)]
  • Non-steroidal anti-inflammatory agents 3
  • Dressings 3
  • Immobilization 3
  • Treatment of local predisposing factors, such as interdigital tinea 3
• Bed rest with the leg elevated is also recommended 4.

Treatment Duration and Outcome

• The median treatment duration is 10 days 3.
• Hospitalization is often required, especially for patients with severe cases or underlying conditions [(3,4,6)].
• Recurrence is a common complication, and long-term antibacterial therapy may be necessary for patients with recurrent erysipelas [(4,5,7)].