RISK FACTORS
β’ Warm, humid environment
β’ Tropical or subtropical climate
β’ Summer or fall season
β’ Minor trauma, insect bites, etc.
β’ Poor hygiene, epidemics, during war, etc.
β’ Familial spread
β’ Poor health with anemia and malnutrition
β’ Complication to pediculosis, scabies, chickenpox, eczema
β’ Contact dermatitis (Rhus)
β’ Burns
β’ Atopic dermatitis
β’ Contact sports
β’ Children in day care
GENERAL MEASURES Removal of crusts, cleanliness with gentle washing 2-3 times daily. Clean
with antibacterial soap, chlorhexidine or betadine.
DRUG(S) OF CHOICE
Note: Increasing incidence of Staphylococcus resistant to erythromycin may make the following suggestions
inaccurate in your community.
. Nonbullous (minor spread, treat 7 days; widespread, treat 10 days); bullous (treat 10 days)
. Erythromycin base - adults 1 gm/day divided doses q6h in adults. Pediatric 30-40 mg/kg/d q6h.
. Mupirocin (Bactroban) topical ointment apply tid, 7-10 days (nonbullous only). Not as effective on scalp as
around mouth.
. Dicloxacillin - adult 250 mg qid. Pediatric 12-25 mg/kg/d divided q6h
ALTERNATIVE DRUGS
Oral doses:
. 1st generation cephalosporins - children
. Cephalexin: 25-50 mg/kg/24 h divided q6h
. Cefaclor: 20-40 mg/kg/24 h divided q8h
. Cephradine: 25-50 mg/kg/24 h divided q6-12h
. Cefadroxil: 30 mg/kg/24 h divided bid
. 1st generation cephalosporins - adults
. Cephalexin: 250 mg qid
. Cefaclor: 250 mg tid
. Cephradine: 500 mg bid
. Cefadroxil: 1 gm/day in divided doses
. Amoxicillin-clavulanate acid
. Adult: 250 mg tid
. Pediatric: 20-40 mg/kg/day of amoxicillin divided q8h
. Azithromycin
. Adult 500 mg on day 1 followed by 250 mg daily for days 2-5
. Pediatric 10 mg/kg on day 1 followed by 5 mg/kg days 2-5
. Clarithromycin
. Adult 250 mg bid
. Pediatric 15 mg/kg/d bid
. Vancomycin
. Clindamycin
. Ciprofl oxacin plus rifampin (rifampicin)
. Severe bullous disease may require IV therapy such as nafcillin or cefazolin
PATIENT MONITORING If not clear within 7-10 days, culture the lesions
PREVENTION/AVOIDANCE Close attention to family hygiene, particularly hand washing. Avoid
crowding. Treat atopic dermatitis.
POSSIBLE COMPLICATIONS
β’ Ecthyma
β’ Erysipelas
β’ Post-streptococcal acute glomerulonephritis
β’ Deep cellulitis
β’ Bacteremia
β’ Osteomyelitis
β’ Septic arthritis
β’ Pneumonia
β’ Lymphadenitis
EXPECTED COURSE/PROGNOSIS
β’ Complete resolution in 7-10 days with treatment
β’ Antibiotic treatment will not prevent or halt glomerulonephritis as it will with rheumatic fever
β’ If not clear within 7-10 days, culture is necessary to find resistant organism