Skin and soft tissue infections

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Erysipelas

Case report:

In a 68-year-old patients with moderate chronic venous insufficiency in the lower extremities there for two days a painful, edematous and indurated, sharply demarcated red swelling of the left lower leg. The extent of the lesion has grown and is present at the time of consultation about eight times twelve centimeters. The skin impresses as a Organgenhaut. In addition, the patient reported about existing since two days temperatures around 38.8 C. Hematologic there is a leukocytosis of 15,000 leukocytes / ul.

Comments:

The clinical findings of a painful swelling associated with sharply circumscribed redness typical of erysipelas. As a risk factor must be considered in the patient, the chronic venous insufficiency of the lower limb. A erysipelas is usually induced by Streptococcus serogroup A; rare, there are C or G streptococci. Infections with group B streptococci are described only in newborns. A backup of the pathogen can be carried out by means of smear only in ulcerative changes. In a small percentage of patients can be found in streptococcal throat swab; about 5% of the courses are accompanied by a bacteremia. The disease takes a progressive course untreated and can lead to local and systemic Komplikatione. Antibiotic therapy is therefore always indicated.

Therapy:

Mild forms of erysipelas can be treated with oral penicillin therapy [penicillin V (Mega Cillin et al)], in more severe pathologies parenteral treatment with penicillin G (penicillin "Grunenthal", among others) is preferable. The duration of therapy should be ten days like in other streptococcal infections. In oral therapy daily 500 mg four times a penicillin V are given in the parenteral therapy one to two mega should be administered four times daily. The most common side effects of penicillin therapy are gastrointestinal (nausea, anorexia). Before each penicillin therapy is looking to find a penicillin allergy known history, which is a contraindication.

Alternatives:

When penicillin intolerance can with erythromycin 500 mg used four times a day are treated parenterally, with oral therapy with a macrolide may clarithromycin (Klacid; 500 mg twice) Roxithromycin (Rulide; once 300 mg) or azithromycin (total dose administered either 1.5 g at three or five days ZITHROMAX) become. Of course, streptococci also against many other B-lactam antibiotics sensitive, but generally, the administration of B-lactam antibiotics is not indicated with broad antimicrobial spectrum. Staphylococci play only in ulcerative infections within the meaning of superinfection a role here is the use of oral dicloxacillin (INFECTOSTAPH; three to four times a day 0,5 - 1,0 g), flucloxacillin (STAPHYLEX; three to four times daily 0.5 -1.0 g) or clindamycin (SOBELIN; tid 300 mg) possible.

Unsuitable in this case:

Antibiotics with a broad spectrum antimicrobial activity and fluoroquinolones are generally not indicated for the treatment of erysipelas.

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