Skin Infections Treatments

Question 1

Folliculitis

Answer 1

•Warm compresses to area 3-4 times/day for 15-20 minutes
•Cephalexin (Keflex) capsules or suspension
Peds: 25-50 mg/kg/day PO divided q6-12h
Adults: 500mg PO q6-12h x 10 days
•Amoxicillin-Clavulanic Acid (Augmentin) tablets or suspension
Peds: 3 mo and older, <40 kg: 25-45 mg/kg/day PO divided q12h x 10 days
Adults: 500/125mg – 875/125mg tab PO q12h x 10 days
•Sulfamethoxazole-Trimethoprim (Bactrim SS and DS) tablets or suspension
Peds: 8-10 mg/kg/day PO divided q6-12h (2 months and older)
Adults: 800/160mg tab PO q 12h x 10 days
•If you have a patient that has abscess formation, the best treatment is I&D.

Question 2

Impetigo/ Echtyma

Answer 2

Management – Impetigo/Ecthyma
•Mupirocin (Bactroban) 2% ointment or cream (First line treatment)
Apply TID x 3 -7 days; limit to area <100cm2 or length 10cm; reassess if no improvement in 3-5 days.
Oral abx recommended only for those who do not tolerate mupirocin or have more extensive infection
•Cephalexin (Keflex) capsules or suspension
Peds: 25-50 mg/kg/day PO divided q6-12h
Adults: 500mg PO q6-12h x 10 days
•Amoxicillin-Clavulanic Acid (Augmentin) tablets or suspension
Peds: 3 mo and older, <40 kg: 25-45 mg/kg/day PO divided q12h x 10 days
Adults: 500/125mg – 875/125mg tab PO q12h x 10 days

Question 3

Cellulitis/ Erysipelas

Answer 3

Cellulitis/Erysipelas without systemic symptoms:
penicillin
amoxicillin-clavulanate
dicloxacillin
cephalexin
clindamycin
Treatment for approximately 7 days.
Patients with increased risk of MRSA should be treated with
sulfamethoxazole-trimethroprim (Bactrim)
doxycycline

Question 4

Necrotizing Fascitis

Answer 4

•If suspect necrotizing fasciitis, consult surgery immediately
•Treatment includes widespread debridement and broad-spectrum antibiotics
◦Vancomycin IV
Peds: 10-15 mg/kg IV q8-12h
Adults: 15-20 mg/kg IV q8-12h
◦plus Ceftriaxone IM/IV
Peds: 50-100 mg/kg/day IM/IV divided q12-24h
Adults: 1-2g IM/IV q24h

The standard is surgical exploration coupled with IV antibiotics and hemodynamic support.

Question 5

Dermatophytoses

Answer 5

•Treatment centers around topical or oral antifungals
◦Terbinafine (Lamisil) 1% cream (OTC)
Apply bid x 1-4 weeks
◦Terbinafine 250mg tablets
250mg tab PO qd x 2-4 weeks

Management of Tinea: Oral or topical antifungals

Question 6

Candida

Answer 6

•Treatment centers around topical or oral antifungals
clotrimazole 1% cream (OTC)
Apply to affected area bid
Fluconazole (Diflucan) 150mg tablets (adults)
150mg PO x1 (uncomplicated) 150mg PO q72h x 2 doses (severe)
•Education regarding keeping skin dry
Management of Candida: Oral and topical antifungals