Outpatient treatment (mild and moderate forms)
Most patients with primary or infrequently recurring erysipelas (e.g., erythematous or localized erythematous-bullous forms) are treated at home. The main component is timely and full-course antibacterial therapy with oral medications (per os).
One of the following macrolides is prescribed:
- Spiramycin: 3 million IU 2–3 times a day. Course — 10 days.
- Azithromycin: 0.5 g on day 1, then 0.25 g once daily for 4 days (alternative regimen: 0.5 g for 5 days).
- Roxithromycin: 0.15 g twice a day. Course — 10 days.
Intensive care in the hospital
Indications for hospitalization in an infectious diseases department include severe (grade III) and bullous-hemorrhagic forms of the disease. Such conditions are often accompanied by severe intoxication syndrome (hyperpyrexia, repeated vomiting, adynamia), hemodynamic disturbances, and the risk of infectious-toxic shock.
Comprehensive therapy includes:
- Antibiotics: parenteral administration of cephalosporins (cefazolin 1–2 g 3–4 times a day or cefotaxime 1–3 g 2–3 times a day intramuscularly/intravenously for a 10-day course) strictly combined with metronidazole (500 mg twice a day intravenously).
- Detoxification: intravenous infusions of reopolyglucin, 5% glucose solution, normal saline with the addition of 5–10 ml of 5% ascorbic acid solution.
- Symptomatic treatment: use of cardiovascular, diuretic, and antipyretic agents as indicated.
Complicated forms and surgical treatment
The addition of a secondary infection and the development of purulent-necrotic complications (phlegmon, abscesses, tissue necrosis) fundamentally alters the management strategy. Such processes cannot be treated conservatively in an infectious diseases hospital.
The patient requires an urgent surgical consultation. Upon confirmation of the diagnosis, the patient is transferred to a purulent surgery department for surgical intervention and subsequent postoperative management.
Relapse prevention (bicillin prophylaxis)
For patients with recurrent episodes of erysipelas, a regimen of long-acting penicillins is developed. The schedule depends on the nature of the relapses:
- Frequent relapses (≥ 3 times per year): continuous year-round prophylaxis for 2–3 years is indicated. The drug is administered once every 3 weeks (in the first months, the interval can be shortened to 2 weeks).
- Seasonal relapses: prophylaxis is started 1 month before the expected exacerbation season. Administration is carried out once every 3 weeks throughout the entire season plus 1 month annually.
- Adverse residual effects: the drug is administered once every 3 weeks for 4–6 months.
In addition to antibiotics, prevention requires the elimination of microtrauma and hypothermia, treatment of mycoses, underlying endocrine pathology (diabetes mellitus), and lymphatic circulation disorders.
Discharge criteria and clinical follow-up (dispensary observation)
The patient is discharged upon complete clinical recovery: persistent normalization of body temperature, disappearance of intoxication signs, and resolution of acute local inflammatory phenomena.
Important: common residual effects (e.g., persistent edema, desquamation, pigmentation) may persist for weeks and months. They are not a contraindication for discharge.
Outpatient dispensary monitoring is established for individuals:
- With frequent (≥ 3 times per year) or seasonal relapses.
- Having prognostically unfavorable residual phenomena upon discharge.
Briefly: answers to topical questions
What short-acting penicillins are used for initial etiotropic therapy of erysipelas?
Sources indicate that penicillins and semi-synthetic penicillins are the drugs of choice for systemic antibacterial therapy of erysipelas. Natural penicillins are listed as being used for skin and soft tissue infections, including erysipelas.
Specific short-acting penicillins for initial etiotropic therapy of erysipelas are not listed in the sources.
Additionally, it is noted that in severe cases of limb erysipelas, endolymphatic administration of antibiotics is possible, and the duration of therapy lasts until the redness disappears and body temperature normalizes.
Class and exam questions
Is it possible to discharge a patient if they still have leg edema after erysipelas?
Yes, you can. Common residual phenomena, such as moderate edema or persistent lymphostasis, are not a contraindication to discharge, provided that the acute phase and intoxication have been resolved.
Who needs bicillin injections and for how long for prevention?
For patients with frequent relapses (3 or more times per year), bicillin is administered continuously every 3 weeks for 2–3 years. In case of seasonal relapses, it is administered only during the exacerbation season.
What to do if phlegmon develops against the background of erysipelas?
It is necessary to immediately arrange a surgical consultation and transfer the patient to the purulent surgery department for surgical treatment.
What else to study on this topic
- Criteria for diagnosing and assessing the severity of erysipelas
- Anamnesis collection: predisposing factors and background diseases
- Differential diagnosis of erysipelas from thrombophlebitis and contact dermatitis
- Evaluation of local pathognomonic symptoms (Status localis)
- Hemogram changes in the typical clinical course of the infection
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Other topics in the section "Infections of the Integumentary System and Sepsis"
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