Skin infections, treatment

Unlabeled Uses Topical Prophylaxis of minor bacterial skin infections, treatment of dermal ulcer... 

O Impetigo is a skin infection that most commonly afflicts young children. It is caused by group A streptococci or Staphylococcus aureus and is characterized by the development of numerous blisters that rupture and form crusts. Dicloxacillin, cephalexin, and topical mupirocin are considered the antibiotics of choice for treatment of impetigo. 

Recognize when topical versus oral treatment is indicated for a patient with oropharyngeal candidiasis, esophageal candidiasis, and fungal skin infections. 

Miconazole is an imidazole antifungal agent used as miconazole base or miconazole nitrate for the treatment of superficial candidiasis and of skin infections dermato-phytosis and pityriasis versicolor. The drug has also been given intravenously by infusion for the treatment of disseminated fungal infections. Miconazole can be given by mouth in a dose of 120-240 mg, as oral gel four times daily after food, for... 

Systemic therapy with a variety of (3-lactams, macro-lides and lincosamides (clindamycin) has been the cornerstone of skin infection therapy for many years [17]. However, topical antibiotics can play an important role in both treatment and prevention of many primary cutaneous bacterial infections commonly seen in the dermatological practice [18], Indeed, while systemic antimicrobials are needed in the complicated infections of skin and skin structure, the milder forms can be successfully treated with topical therapy alone [18], The topical agents used most often in the treatment of superficial cutaneous bacterial infections are tetracyclines, mupirocin, bacitracin, polymyxin B, and neomycin. 

Rifaximin is broad-spectrum antibiotic, which covers many skin pathogens, whose lack of transcutaneous absorption has been well documented by both animal [8] and human [9] studies. On these grounds, a topical formulation (i.e. cream) containing 5% of the active compound was developed and tested in the treatment of pyogenic skin infections. Some open trials [20, 21] showed the efficacy and safety of the formulation and pointed out the lack of selection of resistant strains after topical application of rifaximin. In any event, drug delivery from the topical formulation is orders of magnitude higher than the... 

These data, taken together, demonstrate that topical application of rifaximin represents an effective and safe treatment of pyogenic skin infections. An additional application of this dermatological formulation would be infection prophylaxis in superficial skin wounds, particularly when used with a dressing that occludes the wound. Prophylactic topical antibiotic use makes particular sense for wounds in which the risk of infection is high, such as those that are likely to be contaminated (accidental wounds, lacerations, abrasions, and burns). Because all traumatic wounds should be considered contaminated, topical antibiotics are a logical measure to prevent wound... 

Table 1. Bacterial eradication at the infection site in patients with pyogenic skin infections after short-term treatment with Authors, year Ref. No. Rifaximin Reference drug... 

The broad antibacterial activity of rifaximin as well as its topical action make this antibiotic suitable for intrapocket administration in periodontal disease. As a matter of fact, local application of rifaximin compares well with tetracyclines and metronidazole in other extra-GI diseases, i.e. skin infections and BY, respectively (see above). On the other hand, rifampicin (rifampin), another rifamy-cin derivative, has been successfully used in the treatment... 

Ena P, Zanetti S, Sechi L, Fadda G Open study on rifaximin topical treatment for skin infections due to pyogenic bacteria. NAM (Milan) 1993 9 325-328. 

Lazzaro C, Calaciura C, Spitalieri S, Lazzaro GC Treatment of pyogenic skin infections Results of a controlled trial with a new topical preparation (in Italian). Aggiornamenti Med Chir(Rome) 1989 13 1—11. 

Palazzini E, Palmerio B Treatment of pyogenic skin infections with rifaximin cream. Eur Rev Med Pharmacol Sci 1993 15 87-92. 

Cannata G, Piccardo G Single-blind study of rifaximin effectiveness and safety for the topical treatment of bacterial skin infections. Biol Med(Rome)1993 15 7-19. 

T Cells May Contribute to the Defects in Innate Immune Response in Atopic Dermatitis Most patients with atopic dermatitis are colonized with S. aureus and experience exacerbation of their skin disease after infection with this organism [2]. In patients with S. aureus infection, treatment with anti-staphylococcal substances can result in the reduction of skin disease. Binding of S. aureus to the epidermis is enhanced by atopic skin inflammation. This is supported by clinical studies demonstrating that treatment with topical corticosteroids or tacrolimus reduces S. aureus counts in atopic dermatitis. 

Elidel cream consists of pimecrolimus, which is a calcineurin inhibitor that is used for eczema or psoriasis. Patients should be advised to avoid alcoholic drink during the treatment period as consumption of alcohol may lead to facial flushing and skin irritation. Side-effects associated with the topical administration of pimecrolimus include a burning sensation, pruritus, erythema and skin infections, including folliculitis and, less commonly, impetigo. 

Jacobs MR. (2007) Retapamulin A semisynthetic pleuromutilin compound for topical treatment of skin infections in adults and children. Future Microbiol 2 591-600. 

Scheinfeld N. (2007) A comparison of available and investigational antibiotics for complicated skin infections and treatment-resistant Staphylococcus Aureus and enterococcus. J Drugs Dermatol 6 97-103. 

A new technology, natural bioactive dressing used as skin substitute has proved useful in wound management. This substitute is about one of the few that can produce fully functional skin. For boils and most skin infections, the most effective treatment appears to be direct... 

Children Safety and efficacy of IV aztreonam have been established children 9 months to 16 years of age. Sufficient data are not available for pediatric patients younger than 9 months of age or for treatment of the following indications/pathogens Septicemia and skin and skin-structure infections (where the skin infection is caused by H. influenzae type b). In pediatric patients with cystic fibrosis, higher doses of aztreonam may be warranted. 

Post-streptococcal glomerulonephritis is the result of infection with the nephritogenic strain of group A hemolytic streptococci. The streptococci are usually isolated from patients with a sore throat and, in developing countries, skin infection like impetigo or infected scabies is an important cause. There is no specific treatment except for antihypertensives, salt restriction and diuretics. Corticosteroids are of no value. The disease is self-limiting but, in some adults, it may progress to chronic renal failure. 

Unlabeled Uses Treatment of infected eczema, folliculitis, minor bacterial skin Infections. 

Treatment of inflammatory acne, anthrax, gonorrhea, skin infections, urinary tract infection (UTI) IM 250 mg/day or 300 mg/day divided q8-12h Dosage in renal impairment ... 

Treatment of corneal ulcers, conjunctivitis and other superficial infections of the eye, pro-phylaxis after injuries to the eye/removal of foreign bodies, adjunctive therapy for trachoma and inclusion conjunctivitis Ophthalmic Solution l-Sdropstolowerconjunc-tival sac q2-3h. Seborrheic dermatitis, seborrheic sicca (dandruff), secondary bacterial skin infections Topical Ointment Apply small amount in lower conjunctival sac 1 -4 times/day and at bedtime. 

Bactericidal drug for both gram positive and negative bacteria. Acts by inhibiting enzymes necessary for carbohydrate metabolism in bacteria. It is available as ointment. Used for the topical treatment of superficial wounds and skin infections. FURACIN 0.2% ointment/cream. 

Uketis II (1946) Treatment of furunculosis and other purulent skin infections with di-phage. Sovetskaia Meditsina (Russian Soviet Medicine ) 3 11-12... 

Mupirocin is indicated for topical treatment of minor skin infections, such as impetigo (see Chapter 61). Topical application over large infected areas, such as decubitus ulcers or open surgical wounds, has been identified as an important factor... 

Retapamulin is a semisynthetic pleromutilin derivative effective in the treatment of uncomplicated superficial skin infection caused by group hemolytic streptococci and S aureus, excluding MRSA. Topical retapamulin 1% ointment is indicated for use in adult and pediatric patients, 9 months or older, for the treatment of impetigo. Recommended treatment regimen is twice-daily application for 5 days. Retapamulin is well tolerated with only occasional local irritation of the treatment site. 

---