Cutaneous Bacterial Infections

Philippine Dermatological Society

Rm. 1015, Front Tower, Cathedral Heights Building
St. Luke’s Medical Center, E. Rodriguez Avenue
Quezon City, Philippines 1102
Telephone No.: 723-0101 loc 2015
Telefax No.: 727-7309
E-mail: pds_org@pldtdsl.net
Website: www.pds.org.ph

Officers and Board of Directors

2009-2010

President Georgina C. Pastorfide, MD

Vice-President Ma. Teresita G. Gabriel, MD
Secretary Rosalina E. Nadela, MD
Treasurer Lonabel A. Encarnacion, MD

Immediate Past President Arnelfa C. Paliza, MD

Board of Directors Bernadette B. Arcilla, MD

Marcellano S. Cruz, MD
Evelyn R. Gonzaga, MD
Daisy K. Ismael, MD
Eleanor L. Letran, MD
Ma. Juliet E. Macarayo, MD
Cecilia R. Rosete, MD

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 Cutaneous Bacterial Infections
Treatment Guidelines on Common
Primary Cutaneous Bacterial
Infections
Impetigo
Impetigo contagiosa is a common superficial bacterial
infection caused by Streptococcus and Staphylococcus
sp. or a combination of both bacteria.
While it is more common in children, it may occur at
any age.
Bullous and non-bullous impetigo represent two clinical
forms.
be applied 2-3x a day for 7-10 days.
• May soak the lesions TID in warm water or saline solu-
tion to remove the crusts
For widespread infections:
• Recurrent disease maybe secondary to the coloniza-
tion of Staphylococcus aureus in the nares. Mupirocin
cream or ointment maybe applied BID to the anterior
nares.
• A penicillinase resistant systemic antibiotic such as
cloxacillin 250 mg, cefalexin 250 mg 4x a day or
sodium fusidate 250-500 mg BID may be prescribed.
See table for other drugs.
Ecthyma

It presents clinically as thin-roofed bullae or more com-
monly ruptured vesicles/bullae which expose a red, moist
base covered by honey-colored crusts with a “stuck-on
appearance”, usually on the face and other exposed
areas.
Prevention
• Antibacterial cleansers
• Screen and treat family members with impetigo
Treatment
For limited local infections:
Ecthyma is a deeper bacterial infection characterized by
an ulcerative staphylococcal or streptococcal pyo­derma,
nearly always of the shins or dorsal feet.
Ecthyma is characterized by a saucer-shaped ulcer with
a raw base and elevated edges. Lesions usually heal
with scarring.
Treatment
• Cleansing with soap and water, followed by app­li­cation
of mupirocin, bacitracin, or fusidic acid cream or oint-
ment, 2-3x a day.

• Mupirocin 2% or fusidic acid ointment or cream is to • Cloxacillin or a first-generation cephalosporin must be

given systemically
Organism Drug of Choice Alternative
Folliculitis
Group Penicillin Erythromycin
A Strep Benzathine PCN Cefalexin The common folliculitis is a staphylococcal infection
involving the superficial portion of the follicular duct
≤6 years old
and presents with perifollicular red papules or pustules
600,000 units, IM
eventually with crust formation. Tenderness may be
>7 years old present.
1.2 M units
Distribution is variable; often the scalp, arms, legs, axillae
Staphylo- Cloxacillin/ Cefalexin and trunk are involved.
coccus Dicloxacillin 40-50 mg/kg
aureus 250 mg QID Treatment
(children) • Heat, friction and occlusion should be avoided or mini-
mized.
Group A Erythromycin Clarithromycin • Antibacterial soap and topical antibiotics like mupi­rocin
Strep 40 mg/kg/day Azithromycin or fusidic acid are effective in limited areas of involve-
& S. aureus (children) Clindamycin ment.
15 mg/kg/day • Oral antistaphylococcal antibiotics (oxacillin, clo­xa­cillin,
(children) cefuroxime, sodium fusidate are indi­cated for extensive
cases.)
MRSA Minocycline Cotrimoxazole
(Methicillin- Sodium fusidate Ciprofloxacin Furuncles & Carbuncles
Resistant 250-500 mg/tab,
Staphylococ- BID or TID A furuncle (boil) is a walled-off, deep, painful, fluctuant
cus aureus) for 7-14 days mass enclosing a collection of pus, often evolving from
staphylococcal folliculitis.
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A carbuncle is an extremely painful, deep, inter­connec­
ted aggregate of infected follicles (coalescing furuncles).
Treatment
• Warm, moist compresses are applied 15 to 30 mi­nutes
several times a day.
• Oral anti-staphylococcal antibiotics for at least 7 days
should be given
• Drainage is the primary management for fluc­tuant le-
sions.
• Nasal carriage of Staphylococcus aureus is era­dicated
by mupirocin 2% cream or fusidic acid cream applied
to the anterior nares BID for 5 days. For persistent colo­
nization, rifampicin 600 mg once a day and cloxa­cillin
500 mg four times a day, for 7 to 10 days is prescribed.
Cellulitis
Cellulitis is an infection of the dermis and subcutaneous
tissue characterized by red, hot, tender and painful plaque
with an ill defined border.
In adults and children this is most often caused by Group A
ß-hemolytic Streptococcus and Staphylo­coccus aureus.
Facial, periorbital, head and neck involvement in chil­dren
less than 2 years old is most commonly caused by H.
influenza.
Treatment
• Warm compresses and analgesics to relieve pain.
• Elevation of an involved extremity hastens reco­very.
• Empiric treatment with antibiotics aimed at Staphy­
lococcal and Streptococcal organisms is appropriate.
• Ampicillin for children because it has coverage for H.
influenza.
• Hib immunization in children has dramatically reduced
the incidence of cellulitis in children less than 2 years
old.
• Hib serves as chemoprophylaxis of household mem­
bers in patients less than 4 years old who are un­
immunized.
Erysipelas
Erysipelas is an acute inflammatory form of cellulitis with
prominent lymphatic involvement
More superficial involvement with margins that are more
clearly demarcated from normal skin.
Prodromal symptoms consist of malaise, chills, fever and
occasionally, anorexia and vomiting.
Treatment
• Penicillin V orally (20 to 50 mg 4x a day) is the drug of
choice. Erythromycin can also be used.
Learn to access drug info on your cellphone. Send PPD to 2600 for Globe/Smart/Sun users.
CPM 12TH ED COMMON PRIMARY CUTAN105 105
Cutaneous Bacterial Infections
• Azithromycin 500 mg on day 1 and 250 mg on days 2
to 5, or clarithromycin 250 to 500 mg every 12 hours
for 7 to 14 days are alternatives for patients who cannot
take penicillin.
Paronychia
Paronychia is an inflammatory reaction involving the folds
of the skin surrounding the nail.
Paronychia is characterized by acute or chronic purulent,
tender, and painful swellings of the tissues around the
nail usually of the fingers.
Causative bacteria are usually Staphylococcus aureus,
Streptococcus pyogenes, Pseudomonas, Proteus sp or
anaerobes.
Treatment
• Protection against trauma. Cover with a bandage or
dressing.
• Incision and drainage should be done on acutely in-
flamed abscesses.
• For acute suppurative paronychia due to S. aureus, a
semisynthetic penicillin or a first-generation cephalos­
porin maybe given orally. Sodium fusidate tablet 250-
500 mg BID or TID is also effective.
Erythrasma
Erythrasma is a chronic, bacterial infection caused
by­ Cory­nebacterium minutissimum. It affects the inter­
triginous areas like the groin, axillae and occasionally
the toes.
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
• Antibacterial cleanser
• Benzoyl peroxide (2.5%) gel daily for 7 days or topical
erythromycin solution BID for 7 days. Topical azoles
are also effective.
• Systemic antibiotic therapy using erythromycin or
tetracycline 250 mg QID for 7 days is prescribed in
resistant cases.
Characteristics of an ideal antibacterial agent for
common skin infections:
1. Should have activity against Staph. aureus (inclu­ding
methicillin-resistant strains) and Strepto­coccus.
2. Low resistance rates
3. Low sensitizing potential
3. No cross sensitivity with other antibiotics
4. Excellent pharmacokinetics
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 Cutaneous Bacterial Infections
Protective device for wound healing

Protect the wound from further damage, such as contact

with dirt, soil or insects, by applying protective gauze or
dressing. Dressings may also help reduce odor and help
absorption of moisture especially in highly exu­dative le-
sions. Wound dressings are also beneficial in improving
the appearance of wound site and may even help promote
the functional use of the affected part.

As a further precaution, dressings must be changed

frequently and disposed immediately.

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 Cutaneous Bacterial Infections
Recommended Therapeutics
The following index lists therapeutic classifications as recommended by the treatment guideline. For the prescriber's
reference, available drugs are listed under each therapeutic class. For drug information, please refer to the Philippine
Drug Directory System (PPD, PPDr, PPD Text, PPD Tabs).

Cephalosporins Ifurax Cliz

Infekor Dalacin C HCl/Dalacin C Palmitate/
First Generation Kefox 250/Kefox 750 Dalacin C Phosphate
Cefalexin Kefstar Klindex
Airex Kefsyn Pharex Clindamycin
Am-Europharma Cefalexin Mericef T3 Actin 0.1% Cream
Bandax Panaxim Powder for Inj (IM/IV) T3 Mycin 1% Topical Solution
Bloflex Panaxim Tab T3 Mycin 1.2% Gel
Cefalin Capsule Plerozef Zindal 300
Cefalin Drops/Suspension Profurex
Celoxone Proxim Macrolides
Clephin Ritemed Cefuroxime Azithromycin
Ceporex Rocef Aztrocin
CFA Rovix Film Coated Tablet Azyth
Difalex Rovix Powder for Injection Zithromax
Drugmaker's Biotech Cefalexin Roxetil Zmax One Dose
Eliphorin Roxicef Clarithromycin
Forexine Roxym Claranta
Halcepin Teikeden-500 Clariget
Keflex Xorimax Clarilide
Lewimycin Zefur Claristad
Lexibase Zefurox Clarithrocid
Lyceplix Zegen Galemin
Madexin Zegen Capsule Klargen
Medilexin Zinacef Klaricid/Klaricid OD
Medoxine Zinnat Klarika
Oneflex
Klarmyn
Oranil
Penicillins Klaz
Pharex Cefalexin
Ampicillin Klaz OD
Ritemed Cefalexin
Ampicin Larizin
Selzef
Ampimax Maclar
Xinflex
Cilisod Macrodin
Zeporin
DLI Ampicillin Maxulid
Cefazolin
Drugmaker's Biotech Ampicillin Onexid
Fonvicol
Eurocin Oracid
Ilozef
Excillin Pharex Clarithromycin
Leklin
Panacta Ritromax
Novazef
Pentrexyl Erythromycin
Plezolin
Polypen Am-Europharma Erythromycin
Stancef
Vatacil Drugmaker's Biotech Erythromycin
Zolival
Benzathine benzylpenicillin Erasymin
Cefradine
Zalpen Erythrocin/Erythrocin DS
Altozef
Benzylpenicillin potassium Ilosone/Ilosone DS
Drugmaker's Biotech Cefradine
Rhea Benzylpenicillin Potassium Pharex Erythromycin
Senadex
Benzylpenicillin sodium Sansacne
Tolzep
Yss Benzylpenicillin Sodium Stiemycin
Velodyne
Cloxacillin Upperzin
Yudinef
Avastoph
Zepdril
Drugmaker's Biotech Cloxacillin Quinolones
Second Generation Encloxil Ciprofloxacin
Cefuroxime Lewinex Ciclodin
Aeruginox Medix Cifloxin
Aeruginox Injection Oxaclen Cipfast-500
Altacef Pannox Capsule Ciprobay/Ciprobay XR
Ambixime Pannox Powder for Injection Ciprofen
Axet Penhance-DS/Penhance 625 Cipromax
Cecavil Pharex Cloxacillin Cipromet
Cefogen Prostaphlin-A Cirok
Cevox Ritemed Cloxacillin Drugmaker's Biotech Ciprofloxacin
Cimex Powder for Injection Secloxin Floxacef
Cimex Powder for Suspension Oxacillin Hyprocel
C-Tri T Prostaphlin Iprolan
Drugmaker's Biotech Cefuroxime Wydox Ipromax
Ecocef Pharex Ciprofloxacin
Educef Lincosamines Proseloc
Elixime Clindamycin Proxazin
Eroxmit Anerocin Proxivex
Furocem Clindal Quinosyn-500

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 Cutaneous Bacterial Infections
Quiprime Benzac AC Gel/Wash Mediplast Eye Pad
Rapiqure Panoxyl Mediplast Hypoallergenic Paper Tape
Ritemed Ciprofloxacin Panoxyl Bar 5% Mediplast Paper Tapes
Sigmacip Panoxyl 4% Cream Mediplast Plastic Strip w/ Acrinol
Xenoflox Anti-infectives (Topical) Mediplast Transparent Strips
Xipro Erythromycin Mentopas Medicated Plaster
Zalvos Sansacne Nexcare Bandages Strips
Ziprocap Stiemycin (Clear and Plastic)
Zunexan Clindamycin Nexcare Micropore Paper Tapes
Zyflox T3 Mycin 1% Topical Solution Nexcare Tegaderm Transparent
T3 Mycin 1.2% Gel Dressing
Sulfonamide Combinations Fusidate sodium Nexcare Transpore Surgical Tape
Cotrimoxazole Fucidin Intertulle
Am-Europharma Cotrimoxazole Mupirocin
Bactille-TS Bactifree
Bactrim Bactroban Cream
Bacxal Forte Bactroban Ointment
Chromo-Z Foskina
Costazole Foskina-B
DLI Cotrimoxazole Muprin
Drugmaker's Biotech Cotrimoxazole
Forteprim Sodium fusidate/Fusidic acid
Globaxol Fucidin Ointment/Cream
Katrim Hopaq
Lagatrim Forte
Macromed Antiseptics
Moxzole Am-Europharma Povidone
Onetrim Betadine Cream 5%
Pharex Cotrimoxazole Betadine Ointment 10%
Procor Betadine Skin Cleanser
Rimezone/Rimezone Forte Betadine Wound Solution
Ritemed Cotrimoxazole Casino 70% Solution
Rotrace Drapolene
Septrin Duac
Soxatrisil Rhea Povidone-Iodine 10% Solution
Syndal Ritemed Povidone-Iodine Solution
Tricomed
Trim-S Fixed-Dose Combinations
Trimetazole/Trimetazole DS Antibacterial, Antifungal &
Trizole Suspension Anti-inflammatory
Candibec
Tetracyclines Kenacomb
Doxycycline Lidex NGN
Biocolyn Nerisona Combi
Doryx Quadriderm
Doxin Triderm
Dyna-Doxycycline Trimycin-H Ointment
Vibramycin Antibiotic & Anti-Inflammatory
Lymecycline Aplosyn 10-N
Tetralysal Aplosyn C
Oxytetracycline Aplosyn N
Noxebron Betnovate-N
Tetracycline Diprogenta
Moncycline Foskina-B
RiteMed Tetracycline Fucicort
Fucidin H
Other Anti-infectives Hoebedic
Rifampin (Rifampicin) Neo-Synalar 10/Neo-Synalar 25
Am-Europharma Rifampicin
Crisarfam Vaccines
Drugmaker's Biotech Rifampicin HiB
Framacin Act-HiB
Natricin Forte Hiberix
Pharex Rifampicin Infanrix Hexa
Refam Infanrix-IPV + HiB
Rexilan Pentaxim
Rifadin Quinvaxem
Rifamax Tetract-HiB
Rimactane Vaxem HiB
Rimaped
Sodium fusidate Medicated Dressings, Plasters and
Fucidin Bandages
Leukoplast Adhesive Plaster
Dermatologicals Mediplast 50% Corn Plaster
Anti-acne Mediplast Assorted Strips
Benzoyl peroxide Mediplast Checker Adhesive Strips

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