Pharm Bacterial Skin Infections

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Predisposing factors for skin infections

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diabetes, immunosuppression, malnutrition, alcoholism, and obesity
-conditions w/ impaired circulation: immobility/venous stasis, PVD

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Continuation.. factors that cause skin infections

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IV drug abuse, animal/insect bites, burns, trauma, scratching (other: topical skin irritants, poor hygiene, tight clothing)

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skin hygiene

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wash hands frequently, to prevent spread of skin infections.
wash affected areas of skin frequently with antimicrobial sopas. use warm water.
avoid scratching skin lesions.
avoid skin irritants (cosmetics, sunscreens, tight clothing/hats, or shaving)

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TX for skin infections

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Physical exam
monitor for clinical signs of systemic infection/bacteremia.
drain pus-->send cultures, debride any necrotic tissue

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impetigo

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-superficial skin infection, begins as scattered, itchy, macules that progress into vesicles that rupture.
-purulent liquid discharge that gives it "honey colored crust"
-HIGHLY contagious, spread by scratching
-affects CHILDREN more than adults

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Impetigo is caused by

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staphylococcus & streptococcus

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Ecthyma

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-deeper, ulcerated impetigo. vesicles below the dermis, that can become shallo ulcers. more chance of scarring.
-affects lower extremities, found in elderly/ debilitated
-more painful and harder to resolve
-TX for up to several weeks

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TX for impetigo & ecthyma

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-mupirocin ointment (apply 3 times daily for 7-10 days)
-dicloxacillin (adults: 250-500 mg q6h; pedi: 25-50mg/kg/day in 4 divided doses)
-clindamycin: PCN allergic pts (adults: 300-400 mg po TID; pedi: 10-20 mg/kg/day in 3 divided doses)

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Impetigo/ecthyma alternative TX's

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-cephalosporins (cephalexin, cefaclor, cefadroxil)
-macrolides (azithromycin, clarithromycin)
-fluroquinolones (if pseudomonas suspected; ciprofloxacin, levofloxacin)

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Cellulitis

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-infection of skin & subcutaneous tissue
-can lead to serious systemic infection
-skin is erythematous, warm & painful to touch
-occur anywhere there is break in skin, NOT always VISIBLE

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cellulitis symptoms

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fever, chills, malaise & edema
-pay attn to sx's (increased pulse and respiratory rate) may indicate bacteremia.

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Pathogens cause cellulitis

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-staphylococcus aureus, streptococcus pyogenes are MC pathogens
-h. influenza in facial cellulitis
-pasteurella in animal bites
-pseudomonas, enterobacter, e. coli in immunocompromised

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Cellulitis continuation

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-lead to more serious infection if NOT treated (diabetic foot)
-diabetics have POLY-MICROBIC infections
-potentially reoccurng

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cellulitis affects who?

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-IV DRUG ABUSERS have high rates of cellulitis & abscess formation at injection sites

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TX for cellulitis

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-severe cellulitis IV tx AND possible would drainage/debridement
(if MRSA is suspected, vancomycin is given)

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necrotizing fasciitis

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-suspected when tx for suspected cellulitis FAILS
-EXTREMELY life threatening

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necrotizing fasciitis looks similar to?

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-looks similar to cellulites, spread is more rapid, tissue destruction is severe & tissue is hard to touch

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TX for necrotizing fasciitis

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hospitalization, IV antibiotics & surgical measures are needed ASAP

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erysipelas is also known as?

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st. anthony's fire

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erysipelas

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-superficial form of cellulitis w/ lymphatic involvement
-bright red, edematous painful lesions w/ elevated borders
-red streaks--> lymphatic involvement
-occurs in lower extremities (areas of pre-existing lymphatic obstruction/edema)

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what causes erysipelas?

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group A streptococci (S. pyogenes)

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TX for erysipelas

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-PCN VK oral 7-10 days (adults: 500 mg po q6h; pedi: 250 mg po 2-3 times/day)
-alternative: clindamycin or erythromycin
-clindamycin (adults: 150-300 mg po q6-8h; pedi: 10-30 mg/kg/day in 3-4 divided doses)

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TX for serious erysipelas

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hospitalization required- PCN G is given IV

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What are the 3 Postular infections?

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1) folliculitis
2) furuncle
3) carbuncles

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folliculitis

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inflammation of hair follicle (can be caused by physical injury, chemical irritation/ infection). superficial infection in dermis

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furuncle

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develops from follicular infection extending to deeper areas of skin.

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furuncle commonly known as

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abscess/boil

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carbuncles

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collection of furuncles when they coalesce and extend to subcutanous tissue

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TX for folliculitis

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-warm compresses to promote drainage
-may use topical antibiotics
-topical antibiotics include: mupirocin, clindamycin or erythromycin (2-4 times per day x 7 days)

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TX for furuncle/ carbuncles

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-moist, warm compresses to affected area
-topical antibiotics (used for folliculitis)
-larger furuncles & all carbuncles require incision and drainage

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Antibiotic TX for furuncle/ carbuncles

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5-10 days directed at staphylococcus may be started for more serious cases/ if there are areas of cellulitis around pustular areas/ if fever occurs
-dicloxacillin 250-500 mg q6h
-cephalexin 250-500 mg q6h
-clindamycin 150-300 mg q6-8h (pts w/ PCN allergy)
-if unresponsive, culture & sensitivity due to increasing MRSA

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animal bites

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-type of puncture wound
-if pt presents w/ 8-12 hours of bite, general would care/ topical tx is standard

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vaccines required for animal bites

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rabies & tetanus vaccines

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if human bite, test for...

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HIV

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TX for animal bites (1)

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-prophylaxis may be given in 3-5 day cours w/ amoxicillin- clavulanic acid

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Alternative to prophylaxis tx for animal bite

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TMP-SMX

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Clinical signs of animal bites

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-12 hours after bite
-pain, swelling, discharge, erythema, fever

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Organisms that cause animal bites

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-dog & cat bites are usually polymicrobial w/ pasteurella, strep, and stap being MC organisms

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TX for animal bites (2)

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-10-14 days oral: amox/clav
-IV therapy: carbepenem (ex: ertapenem), ampicillin-sulbactam/ cefoxitin