Erysipelas is a fiery red, tender, painful plaque with well-demarcated edges and is commonly caused by streptococcal species, usually Staphylococcus pyogenes. S. aureus rarely causes erysipelas. Streptococci are the primary cause of erysipelas. Most facial infections are attributed to group A Streptococcus (GAS), with an increasing percentage of lower extremity infections being caused by non-GAS. The role of S. aureus, and specifically MRSA, remains controversial.
Empiric antibiotic regimens. Normal renal function
One of following oral antibiotics
Cephalexin 500 mg 6-hourly
Amoxicillin-clavulanate 1,2 gr 8-hourly
Levofloxacin 500 mg 24-hourly
or
In critically ill patient needing intravenous administration
One of following antibiotics
Cefazolin 2 g-8 hourly
Amoxicillin-clavulanate 1,2-2,2 gr 8-hourly
Levofloxacin 500 mg 24-hourly
In patients at risk for CA-MRSA or who do not respond to first line therapy consider anti-MRSA antibiotics
Oral options
Minocycline100 mg 12-hourly
Trimethoprim and sulfamethoxazole 160/800 mg 12-hourly
Doxycycline 100 mg 12-hourly
Clindamycin 300–600 mg 8-hourly (high resistance rate)
Tedizolid 200 mg 24-hourly
Intravenous options
Vancomycin 25–30 mg/kg loading dose then 15–20 mg/kg/dose 8-hourly
Teicoplanin LD 12 mg/kg 12-hourly for 3 doses, then 6 mg/kg 12 hourly
Tigecycline 100 mg as a single dose, then 50 mg 12-hourly
Linezolid 600 mg 12-hourly
Daptomycin 4–6 mg/kg 24-hourly
Ceftaroline 600 mg 12-hourly
Dalbavancin 1000 mg once followed by 500 mg after 1 week or 1500 mg one dose
Tedizolid 200 mg 24-hourly
Televancin 10 mg/kg 24-hourly
