[Systemic therapy with antibiotics. Overview of important antibiotics in dermatology]

Systemic antibiotics are used in a targeted fashion, i.e. according to antibiogram whenever possible, otherwise in a calculated or empiric way. The pathogen to be treated can be identified sometimes by the clinical symptoms (e.g. in classical erysipelas) or by microbiological analysis. The latter requires adequate sampling methods. Due to the demographic development, which entails age-related multimorbidity and polypharmacy, criteria for the selection of the correct antibiotic not only encompass the pathogen spectrum and the tissue penetration of the drug, but also the risks for adverse events and unwanted interactions with other drugs.

In this review article the mode of action, mechanisms of resistance, pharmacokinetics, adverse events, and drug interactions of the dermatologically important antibiotics are summarized, as are some relevant indications for their appropriate use in dermatology.

For most bacterial skin and soft tissue infections beta-lactam antibiotics represent the first line therapy. They are efficacious, their adverse events are well known and defined, and they are mostly cost-effective. Penicillins G and V are recommended for classical erysipelas (caused by hemolytic streptococci). For uncomplicated soft tissue infections originating from wounds, which are mostly due to Staphylococcus aureus, the first line therapy are cephalosporins group 1 and 2, or isoxazoyl penicillins. The use of broad-spectrum antibiotics is indicated only for complicated soft tissue infections when a different spectrum of bacterial pathogens is suspected or when (multi-) resistant bacteria are supposed to be the causative organism.