Children - 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 | Dose | Duration |
|---|---|---|
| Penicillin VK | 25-50mg/kg/d PO div tid-qid | 5 days |
| or | ||
| Amoxicillin | 40mg/kg/d PO div tid | 5 days |
ß-lactam allergy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Clindamycin | 20-40mg/kg/d PO div qid | 5 days |
Moderate-severe systemic symptoms
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Penicillin G | 250,000-400,000 units/kg/d IV div q6h | 5-10 days |
| or | ||
| Ampicillin | 100-200mg/kg/d IV div q6h | 5-10 days |
ß-lactam allergy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Clindamycin | 20-40mg/kg/d IV div q8h | 5-10 days |
| or | ||
| Vancomycin | 60mg/kg/d IV div q6h | 5-10 days |