Skin and soft tissue infections

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Impetigo

Case report:

In practice, a four year old boy is presented with a total of three skin lesions. It is four to six cm2 large, erythematous, slightly moist areas of skin that are covered with a thick honey-colored crust. A lesion is located in the forearm, the other two are on the face, specifically localized to the left nostril and in the left ear. The child complains of severe itching, and the mother reported nocturnal scratching at the lesions. Pain is not specified, there is no lymphadenopathy and no fever.

Comments:

In the described skin lesions with pronounced crust formation is a high probability to a superficial streptococcal skin infection called impetigo. The pathogens are usually B-hemolytic streptococci serogroup A. Starting from a colonization of the nasopharynx can these germs lead to an infection of small skin lesions. With rare exceptions, the infection to the superficial areas of the epidermis is limited. Systemic infections with appropriate signs and bacteremic progressions are very rare. The differential diagnosis must occasionally a super infected eczema be thought simplex to a pronounced herpes, a parasitosis (scabies) or. With long-standing lesions, oozing more must be expected of a secondary colonization of the affected areas of skin caused by Staphylococcus aureus beyond.

Therapy:

Penicillin is considered the drug of choice for the treatment of Impetigos. In children, penicillin V (ISOCILLIN et al) four times in a dosage of 50 mg / kg body weight / day may be administered. If the infection occurs in adults, four 0.5 million units should be given daily.

Alternatives:

If oral therapy is not possible, penicillin G (div. Trademark) at a dose of 50,000 units / kg body weight in children and 2.4 million units, can be given the adult. If there is a penicillin hypersensitivity, so should in children with erythromycin (Erythrocin et al .; 10 mg / kg body weight) and in adults with azithromycin (ZITHROMAX); even 500 mg / d) to be treated. The treatment time is usually ten days. Local applications of antibiotics are not recommended. Arises during therapy with penicillins no rapid regression of the skin condition, should be a staphylococcal penicillin effective [for example, Flucloxacillin (STAPHYLEX et al)] are used.

Unsuitable in this case:

Not suitable for the therapy appear substances with wider aims such as Second- and third-generation cephalosporins. Similarly, the administration of tetracyclines, cotrimoxazole (EUSAPRIM et al) or quinolones should be rejected in the event of Impetigos.

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