Antibiotic use in patients with erysipelas: a retrospective study
J Bishara1, A Golan-Cohen, E Robenshtok
1Department of Internal Medicine, Rabin Medical Center (Beilinson Campus), Petah Tiqva, Israel. bishara@netvision.net.il
Background:
Erysipelas is a skin infection generally caused by group A streptococci. Although penicillin is the drug of choice, some physicians tend to treat erysipelas with antibiotics other than penicillin.
Objectives:
To define the pattern of antibiotic use, factors affecting antibiotic selection, and outcome of patients treated with penicillin versus those treated with other antimicrobial agents.
Methods:
A retrospective review of charts of adult patients with discharge diagnosis of erysipelas was conducted for the years 1993-1996.
Results:
The study group comprised 365 patients (median age 67 years). In 76% of the cases infection involved the leg/s. Predisposing condition/s were present in 82% of cases. Microorganisms were isolated from blood cultures in only 6 of 176 cases (3%), and Streptococcus spp. was recovered in four of these six patients. Cultures from skin specimens were positive in 3 of 23 cases. Penicillin alone was given to 164 patients (45%). Other antibiotics were more commonly used in the second half of the study period (P < 0.0001) in patients with underlying conditions (P = 0.06) and in those hospitalized in the dermatology ward (P < 0.0001). Hospitalization was significantly shorter in the penicillin group (P = 0.004). There were no in-hospital deaths.
Conclusions:
We found no advantage in using antibiotics other than penicillin for treating erysipelas. The low yield of skin and blood cultures and their marginal impact on management, as well as the excellent outcome suggest that this infection can probably be treated empirically on an outpatient basis.
Insights
Penicillin remains the preferred antibiotic for treating erysipelas, a common skin infection. Studies show no added benefit from other antibiotics, suggesting empirical outpatient treatment is effective.
Area of Science:
- Infectious Diseases
- Dermatology
- Pharmacology
Background:
- Erysipelas is a bacterial skin infection typically caused by group A streptococci.
- Penicillin is the standard treatment, but alternative antibiotics are sometimes used.
Purpose of the Study:
- To analyze antibiotic prescribing patterns for erysipelas.
- To identify factors influencing antibiotic choice.
- To compare treatment outcomes between penicillin and other antibiotics.
Main Methods:
- Retrospective chart review of adult erysipelas patients from 1993-1996.
- Analysis of patient demographics, predisposing conditions, and infection sites.
- Comparison of antibiotic regimens and hospitalization duration.
Main Results:
- 365 patients were included; 76% had leg infections, and 82% had predisposing conditions.
- Penicillin was used in 45% of cases; other antibiotics were more frequent later in the study, in patients with comorbidities, and in dermatology wards.
- The penicillin group had significantly shorter hospitalizations; no in-hospital deaths occurred.
Conclusions:
- No clinical advantage was observed when using antibiotics other than penicillin for erysipelas.
- Low diagnostic yield from cultures suggests empirical treatment is appropriate.
- Excellent outcomes support considering outpatient management for erysipelas.
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