What is the treatment for erysipelas?

Treatment for Erysipelas

Penicillin is the treatment of choice for erysipelas, administered orally for uncomplicated cases (penicillin V 500 mg every 6-8 hours) or parenterally for severe cases, for 5-7 days. 1

First-Line Treatment Options

• For uncomplicated cases, oral penicillin V 500 mg every 6-8 hours for 5-7 days is recommended as first-line treatment 1
• Alternatively, oral amoxicillin 500 mg three times daily for 5-7 days can be used 1
• Treatment duration of 5-7 days is as effective as a 10-day course for uncomplicated cases, provided clinical improvement is observed 1
• For severe cases requiring hospitalization, parenteral (intravenous) penicillin is recommended 1

Alternative Treatments for Penicillin-Allergic Patients

• Clindamycin (oral 300-450 mg three times daily or intravenous 600 mg every 8 hours) is the preferred alternative for patients with penicillin allergy 1
• Erythromycin (250 mg four times daily) is another option, though there is risk of resistance in some streptococcal strains 1, 2
• Vancomycin (intravenous 30 mg/kg/day in 2 divided doses) may be used for severe cases with penicillin allergy 1

Treatment Considerations

• Erysipelas is primarily caused by streptococci, especially Streptococcus pyogenes, so antibiotic coverage should target these organisms 1
• Blood cultures have low diagnostic yield (positive in only 3% of cases) and are generally not necessary for typical cases 1, 3
• Consider empiric therapy for community-acquired MRSA in patients with risk factors or those who do not respond to first-line therapy 1
• Studies show that penicillin treatment results in shorter duration of fever compared to other antibiotics (1.7 vs. 4.5 days) 4

Adjunctive Measures

• Elevation of the affected area to promote gravity drainage of edema and inflammatory substances 1
• Treatment of potential entry points such as athlete's foot, eczema, or trauma sites 1
• Anticoagulation and non-steroidal anti-inflammatory agents may be used as adjunctive therapy 5
• In uncomplicated cases, systemic corticosteroids may be considered as adjunctive treatment to accelerate symptom resolution 1

Prevention of Recurrences

• Treat predisposing conditions (athlete's foot, venous eczema, lymphedema) 1
• Maintain well-hydrated skin with emollients 1
• Reduce underlying edema through elevation of the limb, compression stockings, or pneumatic pressure pumps 1
• Prophylactic antibiotic therapy with delayed penicillin is recommended for recurrent erysipelas 6

Common Pitfalls to Avoid

• Avoid confusing erysipelas with other forms of cellulitis or skin infections that require different treatment 1
• Avoid prolonging antibiotic treatment beyond what is necessary for uncomplicated cases 1
• Don't overlook potential entry portals that could lead to recurrence if left untreated 1, 6
• Remember that erysipelas diagnosis is primarily clinical, based on the presence of an acute inflammatory plaque, often with associated fever, lymphangitis, and adenopathy 7