Systemic antibiotics

Otic preparations are instilled in the external auditory canal and may be used to relieve pain, treat infection and inflammation, and aid in the removal of earwax. When the patient has an inner ear infection, systemic antibiotic therapy is indicated. 

Acneiform eruption after deep chemical peel is a common phenomenon appearing immediately after reepithelialization. Its etiology is multifactorial and is related to either exacerbation of previously existing acne or is due to over-greasing of newly formed skin. Short-term systemic antibiotics together with discontinuation of any oily preparations will usually provide satisfactory solution. 

It is important to obtain details regarding isotretinoin (Accutane, Roacutane) treatment and history of keloid or hypertrophic scar formation. Isotretinoin use necessitates a delay period of 6-12 months (depending on the skin thickness and oiliness) until chemical peel is performed. Active acne is not a contraindication for chemical peel. In these cases the peel is combined with systemic antibiotics for 2-3 weeks. It is always advisable to consider isotretinoin treatment after the peel to avoid acne flare and scar reappearance. 

Before the peel prophylactic acyclovir, vala-cyclovir or famvir is given to patients with history of recurrent herpes simplex. Systemic antibiotics (minocycline) are important for patients with active acne. 

Systemic antibiotics are indicated for moderate-severe inflammatory acne not responding to topical treatments. Systemic antibiotics act on 1) suppression of P. acnes growth 2) inhibition of bacterial lipases 3) reduction of free fatty acids and 4) reduction of inflammation. Oxytetracycline and its derivatives are the most commonly used oral antibiotics. Second-generation tetracyclines such as minocycline, doxy-cycline and lymecycline present longer half-lives, enhanced bacterial activity and lower... 

If conventional treatment fails, unresolved diaper rash can also lead to secondary bacterial infections. Staphylococcus aureus and streptococci are the most likely pathogens responsible for these infections and require treatment with systemic antibiotics.3 37 While topical protectants may be used as an adjunct in treatment, suspected bacterial infections should always be referred to a physician for accurate diagnosis and the selection of an appropriate antibacterial regimen.34 Figure 62-7 shows a useful algorithm for the effective treatment of diaper dermatitis. 

Prevention is key in the management of pressure sores. Mild superficial pressure sore infections may be treated with topical antimicrobial agents. Systemic antibiotics are indicated for pressure sores associated with spreading cellulitis, osteomyelitis, or bacteremia. 

The most common bisphosphonate adverse effects are nausea, abdominal pain, and dyspepsia. Esophageal, gastric, or duodenal irritation, perforation, ulceration, or bleeding may occur when administration directions are not followed or when bisphosphonates are prescribed for patients with contraindications. The most common adverse effects of IV bisphosphonates include fever, flu-like symptoms, and local injection-site reactions. Osteonecrosis of the jaw occurs rarely if it develops, oral chlorhexidine washes, systemic antibiotics, and systemic analgesics are used based on severity. 

Erythromycin has efficacy similar to tetracycline, but it induces higher rates of bacterial resistance. Resistance may be reduced by combination therapy with benzoyl peroxide. Erythromycin can be used for patients who require systemic antibiotics but cannot tolerate tetracyclines, or those who acquire bacterial resistance to tetracyclines. The usual dose is 1 g/day with meals to minimize GI intolerance. 

When bacteriuria occurs in the asymptomatic, short-term catheterized patient (less than 30 days), the use of systemic antibiotic therapy should be withheld and the catheter removed as soon as possible. If the patient becomes symptomatic, the catheter should again be removed, and treatment as described for complicated infections should be started. 

The use of prophylactic systemic antibiotics in patients with short-term catheterization reduces the incidence of infection over the first 4 to 7 days. 

Systemic antibiotics - In all except very superficial infections, supplement the topical use of antibiotics with appropriate systemic medication. 

Antibiotics are used in dermatology for both infectious and noninfectious skin eruptions. Noninfectious skin eruptions, such as acne vulgaris and acne rosacea, are often treated with systemic antibiotics. The mechanism of action is not clear, although tetracycline inhibits lipases derived from resident flora in the sebaceous follicle Staphylococcus epidermidis, Propionibacterium ac-nes). These lipases cleave irritating fatty acids from triglycerides in sebum, presumably contributing to cutaneous inflammation. 

Several systemic antibiotics that have traditionally been used in the treatment of acnevulgaris have been shown to be effective when applied topically. Currently, four antibiotics are so utilized clindamycin phosphate, erythromycin base, metronidazole, and sulfacetamide. The effectiveness of topical therapy is less than that achieved by systemic administration of the same antibiotic. Therefore, topical therapy is generally suitable only in mild to moderate cases of inflammatory acne. 

Scientists who pursue the total synthesis of natural products may choose a target compound for several reasons. The target may be chosen because it has potentially useful properties in biological systems (antibiotic, anticancer, etc.) because of unique structural elements that make its synthesis particularly challenging, so that its structure can be confirmed or because it has structural elements that make it particularly amenable to synthesis by a newly developed synthetic methodology. 

In topical preparations, the base of erythromycin rather than a salt is used to facilitate penetration. Although the mechanism of action of topical erythromycin in inflammatory acne vulgaris is unknown, it is presumed to be due to its inhibitory effects on P acnes. One of the possible complications of topical therapy is the development of antibiotic-resistant strains of organisms, including staphylococci. If this occurs in association with a clinical infection, topical erythromycin should be discontinued and appropriate systemic antibiotic therapy started. Adverse local reactions... 

Use of systemic antibiotics should be limited to infectious or pronounced superinfected wounds. Only few situations in dermatologic surgery require prophylactic antibiotics, since in cutaneous surgery postoperative infections are too infrequent and insufficiently severe to justify preventive antibiotics. 

In AD increased S. aureus colonization plays a fundamental role therefore, antistaphylococcal therapy is part of a successful management of the disease. Epidermal lipid deficiencies and barrier dysfunction contribute to enhanced S. aureus attachment to the skin and mediate immunological and inflammatory effects including the release of superantigens, additional exotoxins, and exoenzymes, and perhaps bacterial DNA-triggered mechanisms. Therapeutic possibilities include the use of topical antiseptics in cases of microbial-laden atopic eczema, corticosteroids, and specific antibiotic-antiseptic combinations in cases of localized superinfected atopic eczema and systemic antibiotics in cases of generalized superinfected atopic eczema.48... 

Sadick NS. Systemic antibiotic agents. Dermatol. Clin., 2001,19, 1-21. 

Resistance of Propionibacterium acnes to topical and systemic antibiotics is increasing. Therefore you should recommend that Miss EV complete the full... 

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