philippine dermatological society - the filipino doctor 10th ed cutaneous bacteria… · philippine...
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Cutaneous Bacterial Infections
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PresidentVice President
SecretaryTreasurer
Board Members
Immediate Past President
Arnelfa C. Paliza, MDGeorgina C. Pastorfide, MDDonna Marie L. Sarrosa, MDMaria Luz G. Aquino, MD
Marcellano S. Cruz, MDMa. Victoria C. Dizon, MDLonabel A. Encarnacion, MDMa. Teresita G. Gabriel, MDDaisy K. Ismael, MDRosalina E. Nadela, MDSocouer M. Oblepias, MD
Ma. Lorna F. Frez, MD
Philippine Dermatological Society
Rm. 1015 South Tower, Cathedral Heights BuildingSt. Lukes Medical Center, E. Rodriguez Sr. Ave., Quezon City
Email: [email protected] Website: http://www.pds.org.ph
Telephone No: 727-7309; 723-0101 loc. 2015
Officers & Board of Trustees
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Organism Drug of Choice Alternative
Group Penicillin Erythromycin A Strep Benzathine PCN Cefalexin ≤6 years old 600,000 units, IM >7 years old 1.2M units
Staphylo- Cloxacillin/ Cefalexin coccus Dicloxacillin 40-50 mg/kg aureus 250 mg QID (children)
Grp A Strep Erythromycin Clarithromycin & S. aureus 40 mg/kg/day Azithromycin (children) Clindamycin 15 mg/kg/day (children)
MRSA Minocycline Cotrimoxazole (Methicillin- Sodium fusidate Ciprofloxacin Resistant 250-500 mg/tab, Staphylococ- BID or TID cus aureus) for 7-14 days
Treatment Guidelines on Common Primary Cutaneous Bacterial Infections
ImpetIgO
Impetigo contagiosa is a common superficial bacterial infection caused by Streptococcus and Staphylococcus sp. or a combination of both bacteria.
While it is more common in children, it may occur at any age.
Bullous and non-bullous impetigo represent two clinical forms. It presents clinically as thin-roofed bullae or more com-monly ruptured vesicles/bullae which expose a red, moist base covered by honey-colored crusts with a “stuck-on appearance”, usually on the face and other exposed areas.
Prevention• Antibacterial cleansers• Screen and treat family members with impetigo
TreatmentFor limited local infections:• Mupirocin 2% or fusidic acid ointment or cream is to
be applied 2- 3x a day for 7-10 days. Updated! • May soak the lesions TID in warm water or saline
solution to remove the crusts
For widespread infections: Updated! • Recurrent disease maybe secondary to the colo-
nization of Staphylococcus aureus in the nares. Mupirocin cream or ointment maybe applied BID to the anterior nares
• A penicillinase resistant systemic antibiotic such as cloxacillin 250 mg, cefalexin 250 mg 4x a day or sodium fusidate 250-500 mg BID may be prescribed. See table for other drugs.
eCthymA
Ecthyma is a deeper bacterial infection characterized by an ulcerative staphylococcal or streptococcal pyoderma, nearly always of the shins or dorsal feet.
Ecthyma is characterized by a saucer-shaped ulcer with a raw base and elevated edges. Lesions usually heal with scarring.
Treatment• Cleansing with soap and water, followed by application
of mupirocin, bacitracin, or fusidic acid cream or oint-ment, 2-3x a day.
• Cloxacillin or a first-generation cephalosporin must be given systemically
FOllICulItIs
The common folliculitis is a staphylococcal infection involving the superficial portion of the follicular duct and presents with perifollicular red papules or pustules eventually with crust formation. Tenderness may be present.
Distribution is variable; often the scalp, arms, legs, axillae and trunk are involved.
Treatment• Heat, friction and occlusion should be avoided or mini-
mized.• Antibacterial soap and topical antibiotics like mupirocin
or fusidic acid are effective in limited areas of involve-ment.
• Oral antistaphylococcal antibiotics (oxacillin, cloxacillin, cefuroxime, sodium fusidate are indicated for extensive cases.)
FurunCles & CArbunCles
A furuncle (boil) is a walled-off, deep, painful, fluctuant mass enclosing a collection of pus, often evolving from staphylococcal folliculitis.
A carbuncle is an extremely painful, deep, interconnec-ted aggregate of infected follicles (coalescing furuncles).
Treatment • Warm, moist compresses are applied 15 to 30 minutes
several times a day. • Oral anti-staphylococcal antibiotics for at least 7 days
should be given• Drainage is the primary management for fluctuant le-
sions.• Nasal carriage of Staphylococcus aureus is eradicated
by mupirocin 2% cream or fusidic acid cream applied
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to the anterior nares BID for 5 days. For persistent colo-nization, rifampicin 600 mg once a day and cloxacillin 500 mg four times a day, for 7 to 10 days is prescribed.
CellulItIs
Cellulitis is an infection of the dermis and subcutaneous tissue characterized by red, hot, tender and painful plaque with an ill defined border.
In adults and children this is most often caused by Group A ß-hemolytic Streptococcus and Staphylococcus aureus.
Facial, periorbital, head and neck involvement in children less than 2 years old is most commonly caused by H. influenza.
Treatment• Warm compresses and analgesics to relieve pain.• Elevation of an involved extremity hastens recovery.• Empiric treatment with antibiotics aimed at Staphy-
lococcal and Streptococcal organisms is appropriate.• Ampicillin for children because it has coverage for H. influenza.
• Hib immunization in children has dramatically reduced the incidence of cellulitis in children less than 2 years old.
• Hib serves as chemoprophylaxis of household mem-bers in patients less than 4 years old who are un-immunized.
erysIpelAs
Erysipelas is an acute inflammatory form of cellulitis with prominent lymphatic involvement
More superficial involvement with margins that are more clearly demarcated from normal skin.
Prodromal symptoms consist of malaise, chills, fever and occasionally, anorexia and vomiting.
Treatment• Penicillin V orally (20 to 50 mg 4x a day) is the drug of
choice. Erythromycin can also be used.• Azithromycin 500 mg on day 1 and 250 mg on days 2
to 5, or clarithromycin 250 to 500 mg every 12 hours for 7 to 14 days are alternatives for patients who cannot take penicillin.
pArOnyChIA
Paronychia is an inflammatory reaction involving the folds of the skin surrounding the nail.
Paronychia is characterized by acute or chronic purulent, tender, and painful swellings of the tissues around the nail usually of the fingers.
Causative bacteria are usually Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas, Proteus sp or anaerobes.
Treatment• Protection against trauma. Cover with a bandage or
dressing.• Incision and drainage should be done on acutely in-
flamed abscesses.• For acute suppurative paronychia due to S. aureus, a
semisynthetic penicillin or a first-generation cephalos-porin maybe given orally. Sodium fusidate tablet 250-500 mg BID or TID is also effective.
erythrAsmA
Erythrasma is a chronic, bacterial infection caused by Co-rynebacterium minutissimum. It affects the intertriginous areas like the groin, axillae and occasionally the toes.
Present as sharply marginated, brownish-red, scaling patches on affected areas.
Predisposing factors include diabetes, warm, humid climate and prolonged occlusion of the skin.
Treatment• Antibacterial cleanser• Benzoyl peroxide (2.5%) gel daily for 7 days or topical
erythromycin solution BID for 7 days. Topical azoles are also effective.
• Systemic antibiotic therapy using erythromycin or tetracycline 250 mg QID for 7 days is prescribed in resistant cases.
Characteristics of an ideal antibacterial agent for common skin infections:
1. Should have activity against Staph. aureus (including methicillin-resistant strains) and Streptococcus.
2. Low resistance rates3. Low sensitizing potential3. No cross sensitivity with other antibiotics4. Excellent pharmacokinetics
protective device for wound healing
Protect the wound from further damage, such as contact with dirt, soil or insects, by applying protective gauze or dressing. Dressings may also help reduce odor and help absorption of moisture especially in highly exudative le-sions. Wound dressings are also beneficial in improving the appearance of wound site and may even help promote the functional use of the affected part.
As a further precaution, dressings must be changed frequently and disposed immediately.
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Recommended Therapeutics(Drugs Mentioned in the Treatment Guideline)This index lists drugs/drug classifications mentioned in the treatment guideline. Prescribing information of these drugs can be found in PPD reference systems.
CephalosporinsFirst generation Cefadroxil Drozid
Drugmaker's Biotech Cefadroxyl Lexipad
Cefalexin Am-Europharma Cefalexin Cefalin Capsule Cefalin Drops/Suspension Ceporex CFA Drugmaker's Biotech Cefalexin Eliphorin Fablex Forexine Keflex Lewimycin Lexibase Lexum
Lonarel Lyceplix Madexin Medilexin Medoxine
Oneflex Pharex Cefalexin RiteMED Cefalexin Selzef Servispor Sigaflex
Vamsler Cefalexin Xinflex ZeporinCefazolin Fonvicol StancefCefradine Drugmaker's Biotech Cefradine
Tolzep Velodyne Zepdrilsecond generation Cefaclor
Cecavil Ceclobid Ceclor/Ceclor CD Clorcef Clorotir
Drugmaker's Biotech Cefaclor Pharex Cefaclor
RiteMED Cefaclor Verzat/Verzat-ER Xelent
Xeztron Zunecar
Cefotiam CeradolanCefoxitin
Monowel PanafoxCefuroxime C-Tri T Drugmaker's Biotech Cefuroxime
Infekor Kefsyn Panaxim Profurex
RiteMED Cefuroxime Rovix Xorimax Zefur Zegen Zegen Capsule Zinacef Zinnat
penicillinsAmoxicillin Amoxil
Amusa Cilfam Clearamox
Daisamox DLI Amoxicillin Drugmaker's Biotech Amoxicillin Eleomox Globamox Globapen
Himox Lewixin
Medimoxil Megamox Moxillin
Multicare Amoxicillin Novamox
Pediamox Pharex Amoxicillin
Promox RiteMED Amoxicillin
Sterimox Sumoxil Teramoxyl
Trexil Valzimox Vaxman Yugoxil Ampicillin
Ampicin Bactimed DLI Ampicillin Drugmaker’s Biotech Ampicillin Eurocin Excillin Panacta
Pentrexyl Picaplin
Polypen Vatacil
Benzathine benzylpenicillin ZalpenBenzylpenicillin potassium Ritemed Benzyl Penicillin
PotassiumBenzylpenicillin sodium YSS Benzylpenicillin SodiumCloxacillin
Avastoph Drugmaker's Biotech Cloxacillin
Encloxil Lewinex
Medix Oxaclen Pannox
Pharex Cloxacillin Prostaphlin-A
RiteMED Cloxacillin SecloxinCo-Amoxiclav Amoclav Augmentin
Augmex Bioclavid Cax
Clavace Clavoxel Clovimax Drugmaker's Biotech
Amoxicillin + Clavulanic acid Enhamox Exten
NatravoxFlucloxacillin
Drugmaker’s Biotech Flucloxacillin Fluclox
Stafloxin Oxacillin Prostaphlin Wydox Pen G Benzathine
Penadur L-APhenoxymethylpenicillin K
SumapenSulbactam/Ampicillin Unasyn IM/IV Sultamicillin Unasyn Oral Zunamyn Tazobactam/Piperacillin Piptaz Tazocin Ticarcillin sodium/Clavulanate potassium
Timentin
lincosaminesClindamycin Anerocin Clindal Cliz Dalacin C HCl/Dalacin C Palmitate/ Dalacin C Phosphate Pharex Clindamycin Zindal 300Lincomycin
Lincocin
macrolidesAzithromycin Azyth Zithromax Zmax One Dose Clarithromycin Clariget Galemin Klaricid/Klaricid OD Klarmyn Klaz Larizin Maxulid Onexid Pharex Clarithromycin Erythromycin Am-Europharma Erythromycin
Cutaneous Bacterial Infections
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Drugmaker's Biotech Erythromycin Erasymin
Erythrocin/Erythrocin DS Ilosone Pharex Erythromycin RiteMED Erythromycin UpperzinRoxithromycin Guamil Macrol/Macrol Kiddie Pharex Roxithromycin Roxid Rulid RXY Thromyn
QuinolonesCiprofloxacin Ciprobay/Ciprobay XR Cipromax Cipromet Cirok
Drugmaker's Biotech Ciprofloxacin Floxacef Hyprocel Iprolan Ipromax Pharex Ciprofloxacin Proxazin Proxivex Quiprime Xipro Zunexan
ZyfloxGatifloxacin TequinLevofloxacin Floxel Levox Wilovex Moxifloxacin AveloxNorfloxacin Drugmaker's Biotech Norfloxacin
Ellatracid Euroflox Lexinor
Pharex Norfloxacin Uritracin Reformulated Urobacid WinafloxOfloxacin Baciflox Drugmaker's Biotech Ofloxacin
Fluraxid Gyros Inoflox Iquinol Itex Keftil Pharex Ofloxacin
Qiflon Qinolon Pefloxacin
FloxinRufloxacin HCl Uroclar
sulfonamide CombinationsCotrimoxazole Am-Europharma Cotrimoxazole
Bacidal Bactille-TS Bactrim
Bacxal
Chromo-Z Colimox
Cotribase DLI-Cotrimoxazole
Drugmaker's Biotech Cotrimoxazole Globaxol
Kathrex Lagatrim Forte Lictora Macromed
Moxzole Onetrim Pharex Cotrimoxazole Procor
Rimezone/Rimezone Forte RiteMED Cotrimoxazole Septrin Sigatrim Susp/Sigatrim Forte Syndal
Trim-S Trimephar Trimetazole/Trimetazole DS
Trimitrix DS/Trimitrix Susp Trizole Suspension tetracyclinesDoxycycline
Biocolyn Doryx Doxin Vibramycin
Lymecycline Tetralysal
Oxytetracycline Noxebron Terramycin
Tetracycline Moncycline
RiteMED Tetracycline
Other Anti-infectivesCefoperazone/ Sulbactam SulperazoneRifampin (Rifampicin) Am-Europharma Rifampicin Crisarfam Drugmaker's Biotech Rifampicin Fevram Framacin Medifam Natricin Forte Pharex Rifampicin PMI Rifampicin Refam Rexilan Rifadin Rifamax Rimactane Rimaped RiteMED Rifampicin Tub-raxinSodium fusidate Fucidin
DermatologicalsAnti-acneBenzoyl peroxide Benoxyl 5 Benzac AC Gel/Wash Brevoxyl PanoxylMetronidazole Robaz
Anti-infectives (topical)Erythromycin Sansacne StiemycinGentamicin sulfate Garamycin 0.1% Cream/OintmentMupirocin Bactifree BactrobanNitrofurazone Drugmaker's Biotech Nitrofurazone FuracinPolymyxin B Sulfate/Bacitracinzinc/Neomycin sulfate Terramycin Plus Skin OintmentSilver sulfadiazine Flammazine InnoxidermSilver sulfadiazine/Cerium nitrate FlammaceriumSodium fusidate/Fusidic acid Flexid Fucidin Intertulle Fucidin Ointment/Cream Fusoderm 2% Ointment Hopaq
Antiseptics Am-Europharma Povidone-Iodine Betadine Cream 5%/
Betadine Ointment 10% Betadine Skin Cleanser Betadine Wound Solution Drapolene
Fixed-Dose CombinationsAntibacterial, Antifungal & Anti-inflammatory
Clobederm/Clobederm-N Clonate Dermovate NN Kenacomb Lidex NGN Nerisona Combi Quadriderm Triderm Trimycin-H Ointment
Antibiotic & Anti-Inflammatory Aplosyn 10-N/Aplosyn C/Aplosyn N Baycuten N Betnovate-N Clotrasone Diprogenta Fucicort Fucidin H Hoebedic Neo-Synalar 10/Neo-Synalar 25 Terra-Cortril Topical/MS 1%
Vaccines HiB Act-HiB Hiberix Tetract-HiB Vaxem HiB
medicated Dressings, plasters and bandages
Leukoplast Adhesive Plaster Mediplast Assorted Strips Mediplast Checker Adhesive Strips
Mediplast Hypoallergenic Paper Tape
Mediplast Plastic Strip w/ Acrinol Mediplast Sheer Strips (Skintone) Mediplast Transparent Strips