Erysipelas secondary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.
Overview
Secondary Prevention
The mainstay of Erysipelas secondary prevention is prophylaxis for severe cases with high frequency of recurrence.
- Phenoxymethylpenicillin or erythromycin are indicated for prophylaxis for those with severe cases and predisposition to the disease, such as venous insufficiency.[1]
- Research on the efficacy of antibiotic prophylaxis of Erysipelas is not conclusive for complete prevention of recurrence.[2]
- Benzathine penicillin, administered intravenously every 3 weeks for 6 months at 2.4 MU, prevented recurrence during treatment, but cessation of therapy resumed Erysipelas incidence for 25% of the patients.[3]
- Erythromycin was shown to be effective prophylaxis throughout administration.[1][4]
- A randomized controlled trial of phenoxymethylpenicillin and erythromycin were shown to reduce Erysipelas recurrence in patients with venous insufficiency or lymphatic congestion, but relapse still occurred in 10% of the patients in the the treatment arm.[5]
- Efficacy of prophylaxis is dependent on dose volume, time interval of administration, and accurate identification and specification of the pathogen.[5][2]
- Consensus for penicillin concentrations and frequency sufficient for prophylaxis is not yet established.[2]
- More research is needed to determine the efficacy of administration every second week and every third week.
- Doubling the dosage of Benzathine penicillin administered (usually 1.2 MU) may provide longer and more effective prophylaxis.
- Consensus for penicillin concentrations and frequency sufficient for prophylaxis is not yet established.[2]
References
- ↑ 1.0 1.1 Jorup-Rönström C, Britton S (1987). "Recurrent erysipelas: predisposing factors and costs of prophylaxis". Infection. 15 (2): 105–6. PMID 3110071.
- ↑ 2.0 2.1 2.2 Koster JB, Kullberg BJ, van der Meer JW (2007). "Recurrent erysipelas despite antibiotic prophylaxis: an analysis from case studies". Neth J Med. 65 (3): 89–94. PMID 17387234.
- ↑ Duvanel T, Mérot Y, Harms M, Saurat JH (1985). "Prophylactic antibiotics in erysipelas". Lancet. 1 (8442): 1401. PMID 2861358.
- ↑ Kremer M, Zuckerman R, Avraham Z, Raz R (1991). "Long-term antimicrobial therapy in the prevention of recurrent soft-tissue infections". J. Infect. 22 (1): 37–40. PMID 2002231.
- ↑ 5.0 5.1 Sjöblom AC, Eriksson B, Jorup-Rönström C, Karkkonen K, Lindqvist M (1993). "Antibiotic prophylaxis in recurrent erysipelas". Infection. 21 (6): 390–3. PMID 8132369.