CELLULITIS AND ERYSIPELAS

Skin and subcutaneous infections with pain, swelling and erythema usually caused by streptococci, but also staphylococci and occasionally other organisms. Regional lymphadenitis may be present. Erysipelas has a raised demarcated border, whilst the border is indistinct in cellulitis.

The presence of areas of necrosis, haemorrhage or pain out of proportion to the physical signs should raise suspicion of necrotising fasciitis which requires aggressive surgical debridement and broad spectrum antibiotics (e.g. penicillin and metronidazole) as these infections are often polymicrobial.

GENERAL MEASURES

Elevate the affected limb to reduce swelling.

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MEDICINE TREATMENT

For pain:

  • Ibuprofen, oral, 400 mg 8 hourly after meals.

OR

  • Paracetamol, oral, 1 g 4–6 hourly when required to a maximum of 4 doses per 24 hours.

 Antibiotic therapy

If intravenous antibiotics are given initially, patients should be switched to oral agents as soon as there is clinical improvement.

Antibiotics should usually be given for 5–10 days depending on clinical response.

  • Cloxacillin, IV, 1 g 6 hourly.
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When there is clinical improvement, change to:

  • Flucloxacillin, oral, 500 mg 6 hourly.

Penicillin allergy:

  • Clindamycin, IV, 600 mg 8 hourly.

    When there is clinical improvement, change to:

    • Clindamycin, oral, 300 mg 8 hourly.

     

    REFERRAL

    Urgent

    »      For debridement if necrotising fasciitis is suspected, i.e. gangrene, gas in the tissues or haemorrhagic bullae.

    Non-urgent

    »      To surgeon for non-response.

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