Streptococci lead to maximum erysipelas cases hence penicillin remains first-line therapy.
Administration of penicillin is done intramuscularly or orally as it is sufficient for maximum
classic erysipelas cases and it must be given for ten to twenty days.
First-generation marcolide or
cephalosporin like azithromycin or erythromycin can be
utilized in case patient is allergic to penicillin. Some can have cross-reaction with penicillin
due to cephalosporins hence must be used with caution especially in patients having severe
penicillin allergy history such as anaphylaxis.
Staphylococcus aureus coverage isn’t usually required for typical infections but it can be
considered for patients who are not improving with penicillin or those who presently are with
the atypical erysipelas forms including bullous erysipelas. There are few authors who believe
facial erysipelas must be treated empirically using penicillinase-resistant antibiotics like
nafcillin or dicloxacillin for covering possible S aureus infections but supporting evidences
for such recommendations that are lacking.
There are 2 drugs namely pristinamycin and roxithromycin that reportedly have been
extremely effective for treatment of erysipelas. There are many studies that have shown
higher efficiency and lesser adverse affects with such drugs as compared to penicillin. The
FDA (US food and drug administration) currently hasn’t approved these two drugs in United
States but Europe is already using them.
You can also go through clinical guidelines from Infectious Diseases Society of America,
Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections.