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COMMON BACTERIAL INFECTIONS

(2004)

PHILIPPINE DERMATOLOGICAL SOCIETY


Philippine Dermatological Society
Rm. 1015 Front Tower, Cathedral Heights Complex, St. Lukes Medical Center,
E. Rodriguez Sr. Ave, Quezon City
Email: pds@pacific.net.ph Website: http://www.pds.org.ph
Tel/Fax No.: 727-7309 Fax No.: 932-9269

Officers & Board of Trustees

President Francisca C. Roa, MD


Vice President Evangeline B. Handog MD
Secretary Ma. Lorna F. Frez, MD
Treasurer Ma. Teresita Gabriel MD

Board Members Benjamin Bince, MD


Marcellano Cruz MD
Ma. Juiet Macarayo MD
Arnelfa Paliza MD
Georgina Pastorfide MD
Carmela Veronica Reyes MD
Lilian Villafuerte MD

Immediate Past President Amelia V. Tianco, MD


COMMON bacterial infections cpm 7TH eDITION

Treatment Guideline on Common Bacterial Infections


Author: Ma. Teresita G. Gabriel, M.D.

Impetigo Treatment
For limited, localized infections:
Impetigo contagiosa is the most common superficial
bacterial infection produced by Streptococci, Staphy- • Mupirocin 2% or fusidic acid ointment or cream is
lococci, or a combination of both bacteria. used 3x a day for 7-10 days.

More common in children but may occur in any age. For widespread infections:

Bullous and non-bullous impetigo represent two clini- • Oral antibiotics are administered. A penicillinase re-
cal forms. sistant antibiotic such as cloxacillin 250 mg, cefalexin
250 mg 4x a day or sodium fusidate 250-500 mg BID
Presents as thin-roofed bullae or ruptured vesicles which is prescribed. See table for other drugs.
expose a red, moist base covered by honey-yellow
crusts, with "stuck-on appearance".
Ecthyma
Prevention
• Benzoyl peroxide wash (soap bar)/ or any Ecthyma is a deeper bacterial infection characterized by
antibacterial soap an ulcerative staphylococcal or streptococcal pyoderma,
• Check family members for signs of impetigo nearly always of the shins or dorsal feet.

• 20-25% of individuals are nasal carriers Ecthyma is characterized by a saucer-shaped ulcer with
a raw base and elevated edges. Lesions usually heal
with scarring.
Organism Drug of Choice Alternative Treatment
Group Penicillin Erythromycin • Cleansing with soap and water, followed by applica-
A Strep Benzathine PCN Cefalexin tion of mupirocin, bacitracin, or fusidic acid, thrice
a day.
< 6 years old
600,000 units, IM • Cloxacillin or a first-generation cephalosporin must
be given orally or parenterally.
> 7 years old
1.2M units
Folliculitis
Staphylococcus Dicloxacillin Cefalexin
aureus 40-50mg/kg/day
(child) Folliculitis, a staphylococcal infection, is an inflamma-
tion of the hair follicle characterized by papules, pustule,
Amoxicillin erosion or crust.
20 mg/kg/day
GAS & Erythromycin Clarithromycin Distribution is variable, often the scalp, arms, legs, axil-
lae and trunk are involved. It occurs as dome-shaped
S. aureus 40 mg/kg/day Azithromycin pustules with small erythematous halos arise in the
(children) Clindamycin center of the follicle.
15 mg/kg/day S. aureus is the most common infecting organism.
(children)
MRSA Minocycline Cotrimoxazole
Treatment
(Methicillin- Sodium Fusidate Ciprofloxacin
• Heat, friction and occlusion should be minimized.
Resistant 250-500mg/tab,
• Antibacterial soap, warm compresses, and topical
Staphylococcus BID or TID
antibiotics are used
aureus) for 7-14 days
• Mupirocin or fusidic acid is effective in limited, su-
perficial involvement.

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CPM 7TH EDITION COMMON bacterial infections
• Oral antistaphylococcal antibiotics (oxacillin, than 2 years old.
cloxacillin, cefuroxime, Na fusidate are indicated for
• Hib serves as chemoprophylaxis of household mem-
extensive cases.)
bers in patients less than 4 years old who are unim-
munized.
Furuncles & Carbuncles
Erysipelas
A furuncle (boil) is a walled-off, deep, painful, fluctuant
mass enclosing a collection of pus, often involving from
Erysipelas is an acute inflammatory form of cellulitis
staphylococcal folliculitis.
with prominent lymphatic involvement
A carbuncle is an extremely painful, deep, intercon-
Characterized by more superficial and has margins that
nected aggregate of infected follicles (coalescing
are more clearly demarcated from normal skin.
furuncles).
Prodromal symptoms consists of malaise, chills, fever
Treatment
and occasionally, anorexia and vomiting.
• Warm, moist compresses are applied 15 to 30 minutes
Treatment
several times a day.
• Penicillin V orally (20 to 50 mg 4x a day) is the drug
• Drainage is the primary management for fluctuant
of choice. Erythromycin can also be used.
lesions.
• Azithromycin 500 mg on day 1 and 250 mg on days 2
• Nasal carriage of Staph. aureus is eradicated by mupi-
to 5, or clarithromycin 250 to 500 mg every 12 hours
rocin 2% cream or fusidic acid cream applied to the
for 7 to 14 days are alternatives for patients who can-
anterior nares BID for 5 days. For persistent coloniza-
not take penicillin.
tion, rifampin 600 mg once a day and cloxacillin 500
mg 4x a day, for 7 to 10 days is prescribed.
• Oral anti-staphylococcal antibiotics. Paronychia

Cellulitis Paronychia is a condition wherein there is an inflamma-


tory reaction involving the folds of the skin surrounding
the fingernail.
Cellulitis is an infection of the dermis and subcutane-
ous tissue characterized by red, hot, tender-to-painful Paronychia is characterized by acute or chronic puru-
plaque with an indefinite border may cover a small or lent, tender, and painful swellings of the tissues around
wide area the nail.

In adults and children most often caused by Group Causative bacteria are usually Staph. aureus, Streptococ-
A Streptococcus (β-hemolytic) and Staphylococcus cus pyogenes, Pseudomonas, Proteus sp or anaerobes.
aureus. Treatment
Facial, periorbital, head & neck involvement in children • Protection against trauma. Cover with a bandage or
less than 2 years old is most commonly caused by H. dressing.
influenza.
• Incision and drainage should be done on acutely in-
Treatment flamed pyogenic abscesses.
• Warm compresses to relieve pain. • For acute suppurative paronychia due to S. aureus,
• Elevation of the leg hastens recovery. a semisynthetic penicillin or a first-generation ce-
pha- losporin maybe
• Analgesics given orally. Sodium fusidate tablet 250-500 mg
• Empiric treatment with antibiotics aimed at Staphy- BID or TID is also effective.
lococcal and Streptococcal organisms is appropri-
ate.
Leg ulcers
• Ampicillin for children because it has coverage for
H. influenza.
Leg ulcer is a chronic, nonhealing lesion located on the
• Hib immunization in children has dramatically re- medial aspect of the leg associated with chronic venous
duced the incidence of cellulitis in children less insufficiency (F>M), chronic arterial insufficiency, pe-
104 115
COMMON bacterial infections cpm 7TH eDITION

ripheral sensory neuropathy or DM. It is more common methicillin-resistant strains) and Streptococcus.
in the late middle and old age
2. Low resistance rates
Risk factors: circulatory problems, minor injury, mal-
3. Low sensitizing potential
nutrition, sedentary lifestyle
3. No cross sensitivity with other antibiotics
Ulcer formation occurs suddenly after slight trauma.
4. Excellent permeability
The ulcers have sharp, or sloping border and are deep
or superficial.
Patients may have secondary eczematous dermatitis Protective device for wound healing
(stasis dermatitis).
There is a significant long-term morbidity.Leg ulcers Protect the wound from further damage, such as contact
often do not heal unless underlying problem is cor- with dirt, soil or insects, by applying protective gauze
rected or dressing. Dressings may also help reduce odor and
help absorption of moisture especially in highly exuda-
Treatment tive wounds. Wound dressings are also beneficial in
• Control of venous insufficiency. improving the appearance of wound site and may even
help promote the functional use of the affected part.
• Crusts and exudates are surgically debrided.
As a further precaution, dressings must be changed
• The application of occlusive film promotes rapid frequently and disposed immediately.
healing by suppressing crust formation and enhancing
epidermal migration.
• Metronidazole gel applied before dressing helps
decrease odor.
• Continuous wet saline compresses promotes granula-
tion tissue
• Give oral antibiotics to control secondary infection.

Erythrasma

Erythrasma is a chronic, bacterial infection caused by


Corynebacterium minutissimum. It affects the intertrigi-
nous areas of the toes, groins and axillae.
Present as sharply marginated, brownish-red, scaling
patches on affected areas.
Predisposing factors include diabetes, warm, humid
climate and prolonged occlusion of the skin.
Treatment
• Wash with benzoyl peroxide (bar or wash) or any
antibacterial soap
• Benzoyl peroxide (2.5%) gel daily for 7 days or topi-
cal erythromycin solution BID for 7 days. Topical
azoles are also effective.
• Systemic antibiotic therapy using erythromycin QID
for 7 days is prescribed in resistant cases.

Characteristics of an ideal antibacterial agent

1. Should have activity against Staph. aureus (including


116 105
CPM 7TH EDITION COMMON bacterial infections

Philusa

117
COMMON bacterial infections cpm 7TH eDITION

Drugs Mentioned in the Treatment Guideline


This index lists drugs/drug classifications mentioned in the treatment guideline. Prescribing information of these
drugs can be found in PPD reference systems.

Cephalosporins Cefprozil Oramox/Oramox Forte


Cefaclor Procef Pediamox
Ceclobid Cefradine Pharex Amoxicillin
Ceclor/Ceclor CD Sediner Pharmamox
Clorotir Velodyne Polymox
Pharex Cefaclor Velosef Promox
RiteMED Cefaclor Cefradroxil RiteMED Amoxicillin
Xelent Duracef Semoxillin
Cefalexin Cefuroxime Servimox
Aseflex Biogenerics Cefuroxime Shinamox
Biogenerics Cefalexin Kefox Sumoxil
Bloflex Lifurox Teramoxyl
Cefalexin-Vamsler Profurex Zymoxyl
Cefalin Capsule RiteMED Cefuroxime Ampicillin
Cefalin Drops/Suspension Romicef Ampicin
Ceporex Shincef Ampimycin
Cidoxine Zegen Ampin
Cromlex Zinacef Amplivacil
Difagen Zinnat Apamacin
Drugmaker's Biotech Cefalexin Penicillins Bactimed
Eliphorin Amoxicillin Biogenerics Ampicillin
Europharma Cefalexin Aldemox Celidam
Exel Amoxil Cloxamicin
Fensid Amoxsteryl DLI Ampicillin
Fevenil Amoxtrex Drugmaker's Biotech Ampicillin
Forexine Amusa Eurotrexil
Genflex Apamax/Apamax Forte Excillin
Gesenal Athenalyn Genaxcin
Harvexyl Axmel Pensyclox
Keflex Bacihexal Pensyn
Lefex Biogenerics Amoxicillin Polypen
Lexibase Cartrimox Saloxin
Lexum Cilfam Shinapen
Lyceplix Unasyn IM/IV
Clearamox
Medoxine YSS Ampicillin
Curamox
Oneflex Benzylpenicillin
Daisamox
Oranil RiteMED Benzylpenicillin
DLI-Amoxicillin
Pectril Potassium
Drugmaker's Biotech
Pharex Cefalexin UL Benzylpenicillin Potassium
RiteMED Cefalexin Amoxicillin
YSS Benzylpenicillin Sodium
Selzef Eleomox Cloxacillin
Servispor Emilex Biogenerics Cloxacillin
VCP Cefalexin Glamox Cloxamicin
Xinflex Globamox Cloxigen
Zeporin Globapen Drugmaker's Biotech Cloxacil-
Cefatrizine Harvimox lin
Zanitrin Himox Encloxil
Cefazolin IHC-Amoxicillin Europharma Cloxacillin
Biogenerics Cefazolin Intermox IHC-Cloxacillin
Faxilen Jamox/Jamox Forte Interclox
Lupex Littmox Myrex Cloxacillin
Stancef Macropage Oxaclen
Cefotiam Medimoxil Patriflex
Ceradolan Megamox Pharex Cloxacillin
Cefpodoxime proxetil Montecil Prostaphlin-A
Banan Moxigen RiteMED Cloxacillin
Moxillin
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CPM 7TH EDITION COMMON bacterial infections
Co-Amoxiclav Cotrimoxazole PMI Rifampicin
Amoclav Am-Europharma Cotrimoxazole Pyrina
Augmentin Bacidal Ramicin
Natravox Bactille Forte Refam
Oxacillin Bactille-TS Rexilan
Prostaphlin Bactrim Ricyn
Wydox Bacxal Rifadin
YSS Oxacillin Sodium Biogenerics Cotrimoxazole Rifamax
Phenoxymethylpenicillin K Cotrexel Rimactane
Centrapen Cotribase Rimactazid 225/Rimactazid
Megapen Cotrimoxazole-Vamsler 300/
Sumapen DLI-Cotrimoxazole Rimactazid 450/Rimactazid
UL Phenoxymethyl Penicillin K Doctrimox 600
Pen G benzathine Drugmaker's Biotech Rimaped
Penadur L-A Cotrimoxazole RiteMED Rifampicin
Lincosamines Fedimed Tubercox
Clindamycin Genoxzole/Genoxzole Forte
Sodium fusidate
Biogenerics Clindamycin Genzaprim/Genzaprim Forte
Fucidin
Clindal Globaxol
Gutrisul Topical therapy
Dalacin C HCl/ Dalacin Benzoyl peroxide
Palmitate/ Dalacin C Intrafort
Kathrex Benoxyl 5
Phosphate Benzac AC Gel/Wash
Inprosyn-HP Lagatrim Forte
Macromed Benzac W Gel/Wash
Macrolides Microbid/ Microbid DS Brevoxyl
Azithromycin Onetrim Panoxyl
Zithromax Pharex Cotrimoxazole Framycetin sulfate
Clarithromycin Procor Sofra-Tulle
Klaricid/Klaricid OD RiteMED Cotrimoxazole Fusidic acid/Sodium fusidate
Onexid Septrin Fucidin Cream/Ointment
Erythromycin Servitrim Gentamicin sulfate
Am-Europharma Erythromycin Synerzole Bactiderm Ointment
Ditron Thoprim Garamycin 1% Cream/
Drugmaker's Biotech Trihexal Ointment
Erythromycin Trim-S Mupirocin
Erasymin Trimephar Bactroban
Erosuccin Trizole Suspension Metronidazole
Ery-Max Robaz
Erycar Tetracyclines Sodium fusidate
Erycin Minocycline Fucidin Intertulle
Erythrocin/Erythrocin DS Minocin Fusoderm 2% Ointment
Erythrolan Tetracycline
RiteMED Tetracycline Vaccine
Ethiocin Hib
Faulding/DBL Erythromycin Tetracycline-B
Unimycin Act-Hib
Lactobionate Hiberix
Gentrocin Other Anti-infectives
Ilosone Bandages/Dressings
Rifampin (Rifampicin) 3M Active Strips
Pharex Erythromycin Am-Europharma Rifampicin
RiteMED Erythromycin Band-Aid
Biogenerics Rifampicin Leukoplast
Romaxin
Sefavex Carfamin Mediplast Elastic Bandage
Servitrocin Crisarfam Mediplast Gauze Bandage
Dipicin Mediplast Gauze Pads
Quinolones Medigauze Elastic Bandage
Ciprofloxacin Drugmaker's Biotech
Rifampicin Medigauze Gauze Bandage
Ciprobay Micropore First Aid Tape
Cipromet Fevram
Cirok Koccifam
Iprolan Lypro-Cap
Pharex Ciprofloxacin Medifam
Xipro Natricin Forte
Zyflox Odifam
Sulfonamide Combinations Pharex Rifampicin
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