What is the treatment for a head skin infection?

Treatment of Cephalon (Head) Skin Infections

For head skin infections, first-line treatment includes synthetic penicillins, first-generation or second-generation oral cephalosporins, macrolides, or clindamycin, with empiric coverage adjusted based on suspected pathogens and local resistance patterns. 1

Pathogen Considerations

• Most skin infections are caused by Staphylococcus aureus and Streptococcus pyogenes (Group A streptococci) 1, 2
• Community-acquired methicillin-resistant S. aureus (MRSA) is increasingly common and should be considered when selecting empiric therapy 1
• Approximately 50% of MRSA strains have inducible or constitutive clindamycin resistance 1

Treatment Algorithm Based on Severity

Mild Infections (Outpatient Management)

• For localized impetigo: Topical mupirocin is effective 1
• For more widespread infections:
  • First-line oral options:
    • Dicloxacillin (penicillinase-resistant synthetic penicillin) 1
    • Cephalexin (first-generation cephalosporin) 1
    • Clindamycin (if no concern for resistance) 1
    • Amoxicillin-clavulanate 1
  • For suspected or confirmed MRSA:
    • Trimethoprim-sulfamethoxazole 1
    • Doxycycline or minocycline (note: 21% treatment failure reported) 1
• Re-evaluate patients in 24-48 hours if treated with trimethoprim-sulfamethoxazole or tetracyclines to verify clinical response 1

Moderate to Severe Infections (Consider Hospitalization)

• Parenteral therapy recommended for:
  • Severe infection
  • Systemic symptoms
  • Progression despite empiric oral antibiotics 1
• Treatment options:
  • For non-MRSA suspected infections:
    • Ampicillin-sulbactam 1
    • Cefoxitin or ceftriaxone 1
    • Ertapenem 1
  • For suspected or confirmed MRSA:
    • Vancomycin 1
    • Linezolid 1
    • Daptomycin 1

Special Considerations

Immunocompromised Patients

• Require broader empiric coverage and early aggressive treatment 3
• Consider immediate dermatology consultation 1
• Biopsy and surgical debridement should be considered early in management 1
• Empiric coverage may need to include:
  • Antibacterials (including coverage for resistant organisms)
  • Antifungals (if fungal etiology suspected)
  • Antivirals (if viral etiology suspected) 1
• Pathogens may include atypical organisms not commonly seen in immunocompetent hosts 1

Cellulitis and Erysipelas of the Head

• Erysipelas (superficial infection with well-demarcated borders):
  • Usually caused by Streptococcus species
  • Penicillin is the treatment of choice 1
• Cellulitis (deeper infection with poorly demarcated borders):
  • Penicillinase-resistant semisynthetic penicillin or first-generation cephalosporin recommended 1
  • For more severe cases, consider parenteral therapy 1

Duration of Therapy

• Uncomplicated infections: 7-10 days 1
• Complicated infections: 10-14 days 1
• Infections in immunocompromised hosts may require longer treatment 1

Adjunctive Measures

• Elevation of the affected area to reduce edema and promote drainage 1
• Warm compresses may help with pain and promote drainage 4
• Cleansing with antibacterial agents and removal of crusts when present 4
• Surgical drainage for abscesses or fluctuant collections 1

Common Pitfalls to Avoid

• Failing to consider MRSA in empiric coverage, especially with increasing community prevalence 1
• Not re-evaluating patients within 24-48 hours when using trimethoprim-sulfamethoxazole or tetracyclines for suspected MRSA 1
• Overlooking the possibility of deeper or more serious infection in patients who fail to respond to initial therapy 1
• Not obtaining appropriate cultures before starting antibiotics in moderate to severe infections 1
• Neglecting to consider fungal or viral etiologies in immunocompromised patients 1