Erysipelas
- Presents acutely with red, shiny, sharply demarcated border, no fluctuance, and with systemic symptoms.
- If facial, typically has butterfly pattern, +/- ear involvement.
- If extremities, check between toes for fissures +/- tinea pedis; previous streptococcal infection a risk factor.
Usual Pathogens
Group A Streptococci
No/mild systemic symptoms
| Empiric Therapy | Duration | |
|---|---|---|
| Penicillin VK | 250-500mg PO qid | 5 days |
| or | ||
| Amoxicillin | 500mg PO tid |
Penicillin/amoxicillin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Cefuroxime axetil | 500mg PO bid |
Cefuroxime allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Clindamycin | 300mg PO qid |
Moderate-severe systemic symptoms
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Penicillin G | 2-4MU IV q4-6h | 5-10 days |
| or | ||
| Ampicillin | 2g IV q6h |
Penicillin/ampicillin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Cefazolin | 2g IV q8h | 5-10 days |
Cefazolin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Ceftriaxone | 1g IV daily |
Cefazolin and ceftriaxone allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Clindamycin | 600mg IV q8h | |
| or | ||
| Vancomycin | 15mg/kg IV q12h |