What is the treatment for Erysipelas (erysipelas)?

From the Guidelines

Erysipelas should be treated with oral penicillin (500 mg four times daily) or amoxicillin (500 mg three times daily) for 7-10 days, as recommended by the Infectious Diseases Society of America 1. The treatment of erysipelas primarily involves antibiotics targeting Group A Streptococcus, the most common causative organism.

• First-line therapy is oral penicillin V (500 mg four times daily for 5-10 days) or amoxicillin (500 mg three times daily for 5-10 days) as supported by the 2014 update by the Infectious Diseases Society of America 1.
• For penicillin-allergic patients, clindamycin (300-450 mg four times daily) or a macrolide like azithromycin (500 mg on day 1, then 250 mg daily for 4 days) are appropriate alternatives.
• Severe cases requiring hospitalization should receive intravenous penicillin G (2-4 million units every 4-6 hours) or ceftriaxone (1-2 g daily).
• Supportive measures include elevation of the affected area, adequate hydration, and pain management with acetaminophen or NSAIDs.
• Cool compresses may help reduce local inflammation and discomfort.
• Treatment should continue until clinical improvement is evident, typically with resolution of fever within 48-72 hours and gradual improvement of skin findings.
• The 2018 WSES/SIS-E consensus conference also recommends managing impetigo, erysipelas, and cellulitis with antibiotics against Gram-positive bacteria, including streptococci and S. aureus 1.
• The choice of antibiotic should be based on the severity of the infection, the presence of comorbidities, and the risk of MRSA infection.
• In cases where MRSA is suspected, glycopeptides and newer antimicrobials may be considered as treatment options 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 Erysipelas is not explicitly mentioned, but it is a type of skin infection typically caused by Streptococcus pyogenes or other streptococcal species.

The treatment for Erysipelas may involve the use of antibiotics such as erythromycin, given its effectiveness against Streptococcus pyogenes, a common cause of the infection. However, the FDA drug label does not directly address the treatment of Erysipelas.

• Key considerations include:
  • The severity of the infection
  • The susceptibility of the causative organism to erythromycin
  • The potential for resistance to develop during treatment 2 It is essential to consult a healthcare professional for proper diagnosis and treatment.

From the Research

Treatment for Erysipelas

The treatment for erysipelas typically involves the use of antibiotics.

• The reference therapy for erysipelas is penicillin G given intravenously 3.
• However, other antibiotics such as roxithromycin can also be effective in treating erysipelas, with an overall efficacy rate of 84% compared to 76% for penicillin 4.
• Penicillin remains the 'gold standard' treatment for erysipelas, but other drugs may also be indicated due to their pharmacodynamic properties 5.
• The use of oral antibiotics such as penicillin or other antimicrobial agents can be effective in treating erysipelas, with no significant difference in outcome compared to intravenous penicillin 6.

Factors Affecting Treatment

The choice of treatment for erysipelas can be influenced by several factors, including:

• Severity of symptoms, such as fever, impairment of general condition, and local signs and symptoms 3.
• Presence of underlying conditions, such as diabetes, alcoholism, obesity, and cardiovascular disease 3, 6.
• Practical modalities of treatment, such as the need for intravenous penicillin or bed rest 3.
• The potential for complications, such as deep venous thrombosis 3.

Treatment Outcomes

The outcomes of treatment for erysipelas can vary depending on the antibiotic used and the severity of the infection.

• Hospitalization was significantly shorter in patients treated with penicillin compared to those treated with other antibiotics 6.
• The use of oral antibiotics can result in excellent outcomes, with no significant difference in outcome compared to intravenous penicillin 6.
• Roxithromycin was found to be an effective and well-tolerated treatment for erysipelas, with no side effects observed in patients treated with this antibiotic 4.