From the Guidelines
For secondary bacterial infections in chickenpox, the recommended antibiotic treatment is typically cephalexin (500mg four times daily for adults; 25-50mg/kg/d in 3-4 divided doses for children) or dicloxacillin (250mg four times daily for adults; 25-50mg/kg/d in 4 divided doses for children) for 7-10 days, as these antibiotics effectively target Staphylococcus aureus and Streptococcus pyogenes, the most common bacteria causing secondary infections in chickenpox lesions 1.
Key Considerations
- The choice of antibiotic should be based on the severity of the infection and the patient's allergy history.
- For patients with penicillin allergy, clindamycin (300-400mg four times daily for adults; 20mg/kg/d in 3 divided doses for children) is a suitable alternative 1.
- In cases of more severe infections or those not responding to oral therapy, intravenous antibiotics such as nafcillin or oxacillin may be necessary 1.
- It is essential to note that the treatment of secondary bacterial infections in chickenpox should prioritize the prevention of complications like cellulitis, abscess formation, or systemic infection.
Antibiotic Options
- Cephalexin: 500mg four times daily for adults; 25-50mg/kg/d in 3-4 divided doses for children
- Dicloxacillin: 250mg four times daily for adults; 25-50mg/kg/d in 4 divided doses for children
- Clindamycin: 300-400mg four times daily for adults; 20mg/kg/d in 3 divided doses for children
Important Notes
- The treatment of secondary bacterial infections in chickenpox should be guided by the severity of the infection and the patient's overall health status.
- The use of antibiotics should always be based on a thorough clinical evaluation and, when possible, supported by microbiological evidence 1.
From the Research
Secondary Bacterial Infections in Chickenpox
Secondary bacterial infections in chickenpox (varicella) can be caused by various bacteria, including Staphylococcus aureus and Streptococcus pyogenes. The choice of antibiotic depends on the severity of the infection and the susceptibility of the bacteria to different antibiotics.
Antibiotic Options
- For methicillin-susceptible Staphylococcus aureus (MSSA) infections, penicillinase-resistant penicillins (e.g., flucloxacillin, dicloxacillin) are the preferred choice 2, 3.
- For methicillin-resistant Staphylococcus aureus (MRSA) infections, parenteral vancomycin or teicoplanin are recommended 2, 3.
- For less serious MSSA infections, such as skin and soft tissue infections, first-generation cephalosporins (e.g., cefazolin, cephalexin), clindamycin, and erythromycin may be used 2.
- For Streptococcus pyogenes infections, penicillins (e.g., ampicillin, amoxicillin) and cephalosporins (e.g., cefpodoxime proxetil) are effective 4.
Specific Antibiotics Used in Chickenpox
- A study on the therapeutic approach to chickenpox in children and adults found that Co-Amoxiclav was the most frequently used antibiotic in adults, while Ceftriaxone was the most frequently used antibiotic in children 5.
Key Points
- The choice of antibiotic for secondary bacterial infections in chickenpox depends on the severity of the infection and the susceptibility of the bacteria.
- Penicillinase-resistant penicillins and vancomycin are effective against Staphylococcus aureus infections.
- Penicillins and cephalosporins are effective against Streptococcus pyogenes infections.
- Co-Amoxiclav and Ceftriaxone are commonly used antibiotics in the treatment of chickenpox with secondary bacterial infections 5.