Skin infections

Question 1

What are common skin infections?

Answer 1

Cellulitis
impetigo
bites
MRSA
Lymes

Question 2

What symptoms of cellulitis?

Answer 2

-Fever with chills and sweating.
-Fatigue.
-Pain or tenderness in the affected area.
-Skin redness or inflammation that gets bigger as the infection spreads.
-Skin sore or rash that starts suddenly, and grows quickly in the first 24 hours.
-Tight, glossy, stretched appearance of the skin.

Question 3

How is the severity of cellulitis categorised and what does each category entail?

Answer 3

Eron classification

Class I- no signs of systemic toxicity and no uncontrolled co-morbidities

Class II- Systemically unwell or systemically well but with comorbidity

Class III- significant systemic upset

Class IV- sepsis

Question 4

How would a patient with class I be managed?

Answer 4

High dose Abx-
flucloxacillin 500-1000mg QDS
for 5 -7 days

or clarithromycin or doxy

or erythro

Question 5

How would you treat a child with class I cellulitis?

Answer 5

Flucloxaiciliin
or
Co-amoxiclav

or

clarithro or erythro

Question 6

Cellulitis:
What is treatment for patients with infection near the eyes or nose who do not require admission or referral?

Answer 6

Co-amoxiclav

or clarithryomycin with metronidazole

Question 7

Cellulitis:
How would you treat a patient with known lymphoedema who develop cellulitis but do not require admission or referral?

Answer 7

Flucloxacillin 500-1000 mg QDS

Amoxicillin (500 mg three times daily) OR
clarithromycin 500 mg twice daily for 14 days.
Note: skin changes (such as discolouration) may persist for months or longer following severe cellulitis and do not necessarily require ongoing antibiotics.

Question 8

What is lymes disease?

Answer 8

A form of arthritis caused by bacteria that are transmitted by ticks (insect).

Question 9

What is treatment option for early limes disease or lyme arthritis?

Answer 9

Doxycycline
amoxicillin (Unlicensed)
Azithromycin

or macrolide if these are contraindicated

Question 10

What treatment is used for lymes associated with cardiac or neurological complications?

Answer 10

IV administration of
ceftriaxome
Doxycycline

Question 11

How long is duration of treatment for lymes disease?

Answer 11

2-4 weeks

lyme arthritis;
may need further treatment

Question 12

MRSA:
What is MRSA

Answer 12

Methicillin-resistant staphylococcus aureus

Question 13

What treatment can be used to managed MRSA infections?

Answer 13

-A tetracycline alone

-Combination of Rifampicin + Fusidic acid can be used for skin and soft-tissue infections

• Clindamycin alone is an alternative.

SEVERE:
-Glycopeptide
-Linezolid

But as these are not active against Gram Negative organism’s, it must be given with other antibacterials if the infection involves Gram Negative organisms. A combination of a Glycopeptide + Fusidic acid or a Glycopeptide and Rifampicin can be considered for skin + soft-tissue infections that have failed to respond to a single antibacterial.