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Impetigo & Ecthyma

Impetigo & Ecthyma

& Ecthyma (1 of 10)

1 Patient (usually a child) presents w/ skin lesions that are suggestive of impetigo or ecthyma

2 DIAGNOSIS No ALTERNATIVE Is impetigo or ecthyma DIAGNOSIS confi rmed?

Yes

3 THERAPY Topical DECISION Oral Does clinical condition warrant antibiotic use of a topical or oral antibiotic?

A Pharmacological therapy A Pharmacological therapy (Topical) 1st-line: 1st-line: • • 2nd-line: 2nd-line: Any one of the following oral agents: • Bacitracin • Aminopenicillin/beta-lactamase inhibitor • Mupirocin • Cephalosporin (1st generation) • • Cephalosporin (2nd generation) B Patient education • Alternative • Cephalosporin (3rd generation) B Patient education

• FOLLOW-UP REVIEW DIAGNOSIS & THERAPY Yes Improvement after No 7-10 days of treatment? • ASSESS COMPLIANCE W/ THERAPY & HYGIENE MEASURES • DO CULTURE & SENSITIVITY NO FURTHER TREATMENT NECESSARY - Swab beneath lifted edge of • crusted lesion Longer treatment may be needed for ecthyma • - Nasal passage swab for TREAT BASED ON suspected carriers of CULTURE & Staphylococcus aureus SENSITIVITY RESULTS © • NASALMIMS MUPIROCIN FOR S aureus CARRIERS

Not all products are available or approved for above use in all countries. Specifi c prescribing information may be found in the latest MIMS.

B168 © MIMS 2019 IMPETIGO & ECTHYMA • • • TestsLab • • • • • • Ecthyma • • • • • Impetigo Bullous • • • • • • • • Impetigo Nonbullous Presentation Clinical • • • • Ecthyma • • • Impetigo or suspected to be caused by Methicillin-resistant by Saureus (MRSA) caused tobe or suspected anoutbreak, Take tobe suspected recurrent, cultures when patient issevere, ill&when blood infection appears - cocci Gram-positive show ofvesicles stainsmears Gram - the patient fi fails rst treatment toconfi stain&/orcultureGram used may be when the therm diagnosis presentation clinical orif isunclear grounds ismadeonclinical diagnosis Tests because cases inmost are notnecessary pathogen the butisusuallyasecondary lesions ); pyogenes streptococciStreptococcus ( : GroupAbeta-hemolytic Etiology hygiene &malnutrition, heat &highhumidity poor pediculosis, scabies, bites, Insect factors: Predisposing are usuallyfoundontheLesions legs w/scarring w/pain&; heals Associated Ulceration isfrequently adherent covered by crusts - that ulcerated pustules &vesicles become as initiallyappear Lesions mellitus (DM) w/ diabetes yr,Typicallymth-18 orpatients inthe elderly, occurs inchildren 6 HIV), immunocompromised (eg neutropenia, skinsyndrome ofstaphylococcal form scalded Alocalized - S aureus coagulase-positive by caused Always Etiology: morethe frequently trunk aff around the diaper area inneonates, ected; &extremities, perineum foundonthe multiple, are face, often buttocks, rapidlyLesions &typically spread, symptoms Generally, butmay therehavelymphadenopathy, regional erythema isnosurrounding painorsystemic - that contain yellow serous fluid that vesicles into turn as fl onintact develop skin&begin typically (0.5-3cmindiameter) Lesions accid bullae &younger children are commonlyNewborns affected carrier asymptomatic may 4%ofadults be state: Carrier streptococci (GABS) A beta-hemolytic Saureus &group Etiology: atopic dermatitis eczema, eg skindisease prior orburns; simplex), scabies (chicken herpes infections viral pox, wounds, bites, insect inthe aff climate; Poor skinbreaks hygiene; preceding crowding; warm factors: Predisposing from area ected ofthe skinonthe areas face (esp &mouth) around the &extremities nose foundonexposed are typically Lesions adenopathy thoughUsually local asymptomatic iscommon; orpainmay pruritus occur occasionally crusts Purulent honey-colored discharge &forms dries - Vesicles quickly pustulate anerosion &rupture orclusters leaving oferosion - orpapules that w/macules Initially presents smallvesicles quickly become commonlyMost occurs inchildren ofage 2-5yr contagiosa orimpetigo impetigo crusted as known common also Most ofimpetigo; form presentation onclinical isusuallybased Diagnosis orasuperinfection adenovoinfection May be occur inchildren &elderly cases Most margins violaceous ulcers &elevated “Punched-out” w/yellow crust - ulcerated that ofimpetigo form extends totheDeeply dermis inchildren esp 2-6yr aged Complication: ofglomerulonephritis Risk inapproximately w/oscarring 14 days occur inchildren spontaneously &resolve cases Most superfi contagious, A very contact inclose amongpeople spreads that skininfection cial, bacterial easily

are suspected the causativeCulture agents reveals test &the &sensitivity appropriate therapy when esp resistant organisms © MIMS light crust athin brown forms varnish-like which then athinofscale, by rim surrounded erosion appears &amoistred-surfaced rupture easily Bullae Impetigo &Ecthyma(2of10) 1 IMPETIGO &ECTHYMA IMPETIGO 2 DIAGNOSIS B169 is typically cultured from from cultured S aureus istypically © MIMS 2019 • • Mupirocin • • Bacitracin TopicalOther • • Fusidic Acid • • Topical Antibiotics • Referral • • Others • •  Antibiotic Oral erapy • • Topical  Antibiotic erapy • • • • Diagnosis Alternative Carriers ofSaureus intheir w/mupirocin are nares ointment treated Carriers nasally applied - fortreatment sideeff &Cefalexin) fewer &produces ofimpetigo than oralagents ects Eff eff as proven tobe been Has ects: Fusidic oralantibiotics (eg as Ampicillin,ective acid&several Dicloxacillin, Eff ects: impetigo therapy topical formany forlocalized as Used years Active staphylococci against (including Methicillin-resistant strains)&streptococci - Eff ects: 1st-line antibiotic topical ofcontact to2 wkduerisk &antibiotic limited sensitization resistanceUse should be development the isnotrecommended ofhealing during process ofscabs Removal - cloth w/awet compress crusts Soften - toenhance removal crust penetration after applied Must be Recurrence isfrequent - setting care therapy inprimary tomaximal orunresponsive isextensive, severe, Infection - isunclear Diagnosis - considered may ordermatologist when: be A referral toapediatrician eff skinreactions tocause tendency & its ectiveness Topical (eg antiseptics its Hydrogen regarding evidence are peroxide cream) duetolimited notrecommended communicable &may generalized become since lesions untreated ishighly impetigo forlocalized aloneare even notrecommended Hygiene measures ecthyma forwidespread Parenteral antibiotics needed may be etc), orinimmunocompromised, unable recurrent those totolerate infection antibiotics topical wherebullous impetigo, ecthyma patientsinvolvement there of deep in cases is evidence (eg furunculosis, , the near mouth, lesions nonbullousimpetigo, widespread Preferred treatment inpatients symptoms, w/systemic impetigo) ofinvolvement totreat orsmallareas singlelesions Used (localized theantibiotics near mouth) ifapplied away the from mouth located (child nonbullousimpetigo may appropriateMay lick be inlocalized topical - oftreatmentDuration according istailored improvement toclinical pemphigoid, foliaceus Bullous pemphigus Rare: necrolysis toxic epidermal syndrome, Stevens-Johnson bites, insect reaction, drug contact dermatitis, &scalds, burns Atopic eczema, Non-infectious: ,HSV, varicella ecthyma, scabies, dermatophytosis, cellulitis, Candidiasis, Infectious:

Methicillin-resistant strains)&streptococci 2nd-lineoftreatment Fusidic as Considered after staphylococci itisactiveagainst acid,as (including forthedays 7 C&Sresults whilewaiting toextend beyond itisreasonable ordeteriorating, If unresponsive © eff tobe shown been Has Astreptococci Saureus against andgroup ective eff clinically as proven tobe been Has Mupirocin as ective MIMS Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing A PHARMACOLOGICAL THERAPY Impetigo &Ecthyma(3of10) 2 3 DIAGNOSIS (CONT’D) THERAPY DECISION B170 © MIMS 2019

IMPETIGO & ECTHYMA IMPETIGO & ECTHYMA • • • • (3rdGeneration) Cephalosporins • (2ndGeneration) Cephalosporins • • (1stGeneration) Cephalosporins • • Penicillins Antistaphylococcal • Antibiotics Oral • • • • Retapamulin • • • • • • Co-trimoxazole Antibiotics Oral Other - Erythromycin - Eg , orRoxithromycin Alternative forPenicillin-allergic patients - coverageGram-negative Variable &noinherent MSSA organisms esp advantage tothe broader intheir Gram-positive against activity Cefaclor, are amongthe &Cefuroxime Cefprozil choices notcoverDo MRSA &isgenerallyExcellent well-tolerated &Spyogenes Saureus (MSSA) Methicillin-susceptible against activity Staphylococcus by caused aureus tissueinfection (MSSA) andother forImpetigo skinandsoft Indicated - Amoxicillin +Clavulanate notcover MRSA Does - Very eff tolerated compared butless toCefalexin ective - toinitiate therapy used when May staphylococcal be issuspected infection - staphylococci penicillinase-producing For by caused infections - Dicloxacillin &Flucloxacillin cost availability resistance &product patterns, organism, local Choice ofagent onsuspected depend will - Eff ects: Suitable alternative toFusidic acid cost ofits a2ndlinetreatment as Considered because agentNew treatment fortreating w/ashort impetigo duration ofonly5 days Contraindicated in children ≤8 yr & during pregnancy inchildrenContraindicated &during ≤8yr considered infections May formildtomoderate MRSA be Eg , choice inpatients formildtomoderate bullousimpetigo communities from resistanceGood w/highMRSA strain Erythromycin-resistant by caused infections high-inoculum however, choice infections; MRSA forsusceptible thereGood isapotential development ofresistance w/ community-acquired against activity butnottostreptococci MRSA good very Has notcover MRSA Does -

community Typically considered treatment inthe resistance ofchoice iswidespread Erythromycin unless toErythromycin rates superior ininstances cure ofintolerance esp advantageous butdonotprovide May be toErythromycin pressure foremergence selective tends toexert ofactivity anincreased ofantibiotic resistance Broad spectrum Methicillin-resistant against In data activity staphylococci show vitro © MIMS Active Saureus against &streptococci Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not A Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing PHARMACOLOGICAL THERAPY (CONT’D) Impetigo &Ecthyma(4of10) B171 © MIMS 2019 • • Prevention • • • • • • • (TM)) (TM)) Trimethoprim & (SMZ) ( Sulfamethoxazole Co-trimoxazole Kanamycin Use of insect repellant to prevent insect bites repellant toprevent insect Use ofinsect Prompt attention them antibiotic topical &applying clean keeping tominorwoundseg therapy ifcondition starting worsened orsooner after ifcondition toreturn did notimprove butpatient 7 days advised shouldbe isnotneeded Routine follow-up Improve nutritional status &treat underlying conditions the patientAdvise fi tokeep &toavoidngernails short scratching the lesions soap &water oftheDaily cleaning w/anantiseptic may lesions prevent recurrence at distant sites Dailybath w/soap &water - persons contact handsafter ofinfected Practice w/lesions washing simple eg cleanliness Child must until initiation todaycare notreturn ofantibiotic 24-72 hrafter orschool treatment To etc sheets, patient prevent spread, &avoid should avoid oftowels, sharing contact persons w/noninfected

Drug Drug Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All © MIMS 12 hrly divided kg/day PO 30 mg/ SMZ: on Based 12-24 hrly kg/day IM 30-50 mg/ Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not hlnAdults Childn Adults Childn Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing ANTIBACTERIAL COMBINATIONS Dosage Dosage Impetigo &Ecthyma(5of10) B Dosage Guidelines 12 hrly TM PO SMZ/160 mg 800 mg 12-24 hrly 1-2 gIM PATIENT EDUCATION B172 • • • Instructions Special • Reactions Adverse • • Instructions Special • Reactions Adverse w/ hematological disorders w/ hematological Use w/ extreme caution ornotat allinpatients Sulfonamides inpatientsContraindicated allergic to Maintain adequate fluid intake eff inthe urine) (crystallization ect Genitourinary syndrome); Stevens-Johnson (rash, reactions Hypersensitivity photosensitivity); effDermatological pruritus, (rash, ects GI eff (N/V,ects diarrhea); anorexia, in patientsContraindicated to w/allergy lactation impairment &poornutrition,inpregnancy Use w/caution inthe elderly, patients w/renal Nephrotoxicity, ototoxicity Remarks Remarks © MIMS 2019

IMPETIGO & ECTHYMA IMPETIGO & ECTHYMA (1stGeneration) Cephalosporins 14 mg/kg/day PO Cefditoren Cefdinir (3rdGeneration) Cephalosporins Cefpodoxime Cefuroxime Cefprozil Cefotiam Cefaclor (2ndGeneration) Cephalosporins 25-50 mg/kg/day Cefradine 25-50 mg/kg/day 30 mg/kg/day PO Cefalexin Cefadroxil Drug Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products 8 hrly PO 3-6 mg/kg/dose Fine granules 12 hrly ordivided 24 hrly divided 12 hrly divided 8-10 mg/kg/day PO day Max dose:250 mg/ 12 hrly divided PO kg/day 12 hrly or 20 mg/ 125 mgPO >2 yr: 12 hrly 24 hrlyday or PO 20 mg/kg/ >2 yr: 8 hrly divided kg/day PO >1 mth:20-40 mg/ 6-12 hrly divided PO 6-12 hrly divided PO 12 hrly divided placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All © MIMS Childn Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage Impetigo &Ecthyma(6of10) Dosage Guidelines 200 mg PO 12 hrly 200 mg PO 8 hrly 100 mg PO 8 hrly 100 mg PO 12 hrly 12 hrly 200-400 mg PO 250-500 mg PO 250-500 mg PO 24 hrly or 500 mgPO 250 mg PO 12 hrly 8 hrly divided 300-600 mg/day PO 8 hrly 250-500 mg PO 12 hrly 500 mg PO 250 mg PO 6 hrly 6-12 hrly 500 mg PO 250 mg PO 6 hrly 12 hrly or divided 24 hrly1 g/day PO CEPHALOSPORINS Adults B173 or or • • • • Instructions Special • • • Reactions Adverse Treat for7-10 days impairment Use w/caution inpatients w/renal cross-sensitivity Penicillin, there 10%chance may be of Use w/caution inpatients allergic to distress gastric todecrease taken w/food May be chain-containing Cephalosporins N-methylthiotetrazole side (NMTT) frequentlyoccur most w/ & reported have been (w/ orw/obleeding) &/orhypoprothrombinemia time (aPTT), thromboplastin partial activated prolonged prothrombinProlonged time(PT), eff (encephalopathy,ects convulsions) w/CNS associated may be High doses infections) Other eff N/V); (diarrhea, (Candidal ect GIeff anaphylaxis); rash, pruritus, ects (urticaria, reactions Hypersensitivity Remarks © MIMS 2019 5-8 mg/kg/day PO 5-8 mg/kg/day PO Roxithromycin divided 30 mg/kg/day PO Midecamycin 30-50 mg/kg/day PO Erythromycin Clarithromycin Azithromycin 10 mg/kg/day PO 24 hrly 10 mg/kg/day PO Azithromycin Oxacillin Flucloxacillin Dicloxacillin Cloxacillin Penicillins Antistaphylococcal of Ampicillin/sulbactam) ( Sultamicillin: Pro-drug Ampicillin/ sulbactam Inhibitors w/Beta-lactamase Aminopenicillins Amoxicillin/clavulanate) acid ( Co-amoxiclav, Amoxicillin/ clavulanic Drug Drug Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed divided 12 hrly divided 6-8 hrly 6-12 hrly divided 12 hrly divided 7.5-15 mg/kg/day PO PO 24 hrly x 4 days 5 mg/kg/day by followed 24 hrly x1dayPO x 3 days or10 mg/kg/day & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All © MIMS Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Childn divided 4-6 hrly divided 50-100 mg/kg/day PO 6 hrly 125-250 mgPO 2-10 yr: 6 hrly PO 25-50 mg/kg 6 mth-2yr: <6 mth: divided 6 hrly divided 12-25 mg/kg/day PO divided 6 hrly divided 25-50 mg/kg/day PO divided 12 hrly divided 25-50 mg/kg/day PO 8-12 hrly divided 25 mg/kg/day PO 25 mg/kg PO 6 hrly 25 mg/kg PO Impetigo &Ecthyma(7of10) Childn Dosage Guidelines Dosage MACROLIDES PENICILLINS 300 mg PO 24 hrly 300 mg PO 12 hrly or 150 mg PO 6-8 hrly divided 800-1200 mg/day PO 12 hrly 500 mg PO 6 hrly 400 mg PO 6 hrly 250 mg PO 1g/day dose: Max 24 hrly 500 mg PO Extended-release: PO12 hrly 250-500 mg Regular-release: PO 24 hrly x4 days PO 250 mg by followed 24 hrly x 1 day 3 days or500 mgPO 24 hrly x 500 mg PO Dosage B174 Adults 6 hrly 500 mg-1 gPO 6 hrly 250-500 mg PO 6 hrly 6 hrly 250-500 mg PO 4g/day dose: Max 6 hrly 250-500 mg PO 12 hrly 375-750 mg PO 375 mg PO 8 hrly 375 mg PO

Adults • • • Instructions Special • • • Reactions Adverse otherwise indicated otherwise Treat for7-10 days unless hepatic dysfunction Use w/caution inpatients w/ distress gastric todecrease May take w/food disturbances than Erythromycin GI less tend tocause &ClarithromycinAzithromycin macrolides w/some haveloss occurred tinnitus/hearing Dose-related infections) Other eff (Candidal ects diarrhea/colitis); associated antibioticdisturbances, other GI diarrhea, discomfort, GI eff (N/V,ects abdominal • • • Instructions Special • • Reactions Adverse Treat for7-10 days w/ renal impairment Use w/ caution inpatients Penicillin allergy Avoid inpatients w/ convulsions) (encephalopathy, eff w/CNS associated ects may be High doses infections) (Candidal Other N/V); (diarrhea, GIeffanaphylaxis); ects pruritus, urticaria, (rash, reactions Hypersensitivity Remarks Remarks © MIMS

2019 IMPETIGO & ECTHYMA Erythromycin B174 E Dicloxacillin B174 D Clindamycin B176 Doxycycline B175 Cloxacillin B174 Co-amoxiclav B174 Co-trimoxazole (Sulfamethoxazole (SMZ) &Trimethoprim (TM) B172

S Retapamulin B176 R B174 Oxacillin O B176 N Midecamycin B174 M B177 L Kanamycin B172 K B175 G Flucloxacillin B174 F Roxithromycin B174 Minocycline B175 Linezolid B177 Fusidic acidB175 Mupirocin B175 IMPETIGO & ECTHYMA Bacitracin hoapeio % %on Apply 6-8 hrly 2%,3%oint Doxycycline Minocycline Fusidic acid Gnaii Various strengths, Gentamicin Drug Drug Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All available preparations are & combinations, Various strengths, kg 24 hrly 2 mg/ by followed 12 hrly divided 4 mg/kgPO >8 yr: 250 mg PO 6 hrly 250 mg PO >12 yr: kg 24 hrly 2 mg/ by followed 12 hrly divided 4 mg/kgPO >8 yr: 2% Na oint fusidate cream 2% Fusidic acid © available preparations are & combinations, MIMS Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Available Strength Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Childn Impetigo &Ecthyma(8of10) Dosage Dosage Guidelines TOPICAL ANTIBIOTICS TETRACYCLINES x 7-10 days Apply 6-24 hrly 24 hrly 100 mgPO by 24 hrly followed 200 mg PO 6 hrly 250 mg PO 6 hrly 50 mg PO 12 hrly or 100 mgPO by daily followed 24 hrly once 100-200 mg PO x 7 days Apply 8-12 hrly Apply 6-12 hrly Dosage Adults B175 • Reactions Adverse • • • Instructions Special • Reactions Adverse • Reactions Adverse • Reactions Adverse • • • Instructions Special • Reactions Adverse Rash, itching Rash, impairment Use w/caution inrenal orhepatic (SLE) erythematosus Avoid in patients lupus w/systemic Take w/plenty offluid whilesitting or - tanning beds Avoid tosunlight or longexposure women) inyounginfants/pregnant growth bone discoloration interference ofteeth, w/ Other eff infections, (Candidal ects effDermatological (photosensitivity); ect taken w/insufficient amount ofliquid); ulceration esophageal when dysphagia, diarrhea/colitis, antibiotic-associated GI eff (N/V,ects diarrhea, Superinfection, allergic reaction Superinfection, Rarely hypersensitivity reactions Rarely hypersensitivity Use w/ caution inpregnancy Aminoglycosides inpatientsContraindicated allergic to occurs orsuperinfection sensitization Avoid discontinue use, prolonged if nephrotoxicity,Irritation, ototoxicity

standing & well before retiring tobed standing &well retiring before Remarks Remarks © MIMS 2019 Mupirocin 2% cream, oint, oint, 2%cream, Mupirocin C idmcn8-20 mg/kg/day Clindamycin 1%oint Retapamulin Various Neomycin Drug Drug Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products nasal oint nasal 6-8 hrly divided PO available preparations are & combinations, strengths, placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All Available

© MIMS Strength Childn Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing (CONT’D) TOPICAL ANTIBIOTICS Dosage Impetigo &Ecthyma(9of10) 5 days Apply 8-12 hrly x carriage: nasal For of elimination to 10 days Apply 8 hrly xup 8 hrly PO 300-400 mg 5 days Apply 12 hrly x Apply 4-24 hrly Dosage Guidelines OTHER ANTIBIOTICS Dosage Adults B176 • Reactions Adverse • • Instructions Special • Reactions Adverse • Reactions Adverse • • • Instructions Special • Reactions Adverse Other eff (tenderness) ect effsensation); CNS headache); (dizziness, ects skin,burning/stinging dry erythema, effDermatological rash, (pruritus, ects Discontinue occurs ifdiarrhea hepatic impairment atopic patients ofcolitis, &renal or w/ history esp Use w/ caution inpatients w/GIdisease (polyarthritis) dermatitis); Othervesiculobullous eff ect eff multiforme, exfoliative/ (erythema ects Dermatological urticaria); (rash, reactions Hypersensitivity taste); pain, metallic N/V, colitis, pseudomembranous abdominal GI eff antibiotic-related severe (diarrhea, ects pyrexia) (headache, contact dermatitis); Other efferythema, ects application pain, siteirritation, diarrhea, effDermatological eczema, (pruritus, ects mucous membranes Avoid or &contact use w/eyes long-term to Neomycin or neuromuscular impairment orw/allergy in patients renal,Contraindicated w/hepatic, elderly ofskindamage & Use w/caution incases ofresistant organismsgrowth , Ototoxicity, sensitization local occasional Remarks Remarks © MIMS 2019

IMPETIGO & ECTHYMA IMPETIGO & ECTHYMA 1 Combination w/ other emollients is available. Please see theCombination forspecifi w/other latest MIMS emollients see isavailable. Please information. c prescribing Linezolid T ilsnBar Triclosan Lincomycin oxide Zinc Drug Drug 1 PO 12 hrly PO 600 mg >12 yr: 12 hrly 10 mg/kg PO 5-11 yr: 8 hrly kg PO 10 mg/ <5 yr: Oint 6-8 hrly divided PO 60 mg/kg/day >1 mth: infections: More severe 6-8 hrly divided PO 30 mg/kg/day >1 mth: infections: Serious Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products Preparation Available placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All © MIMS Childn Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Please see the end of this section for the reference list. reference the for section this of end the see Please Dosage EMOLLIENTS &SKINPROTECTIVES (CONT’D) OTHER ANTIBIOTICS 600 mg PO 12 hrly 600 mg PO 6 hrly >500 mg PO infections: More severe 8 hrly 500 mg PO infections: Serious • • Impetigo &Ecthyma(10of10) healing of damaged skin ofdamaged healing &helps in protects, Soothes, skin cleanser Mild antibacterial &adjunct Dosage Guidelines Adults Indication B177 • • Instructions Special • Reactions Adverse • • • • Instructions Special • Reactions Adverse counts wkly &platelet ofCBC Recommend monitoring dysfunction myelosuppression renal &in patients w/severe Use w/ caution inpatients w/preexisting abnormal LFTs)infection, Other effthrombocytopenia); (moniliasis ects pancytopenia, anemia, leukopenia, myelosuppression(reversible including eff Hematological dizziness); insomnia, ects effcolitis occur); CNS can (headache, ects constipation, diarrhea/ antibiotic-associated GI eff N/V, (diarrhea, ects taste, metallic therapy w/prolonged function Monitor liver &kidney &lactation Lincomycin, innewborns in patientsContraindicated allergic to &asthma disease ofGI Use w/caution inpatients w/history oralintake &after ofLincomycin1-2 hr before Taken ofwater onanempty w/aglass stomach (LFTs), tests function renal dysfunction] administration); Other eff [abnormal liver ects effCVS IV afast after (hypotension ect effDermatological urticaria); (skinrashes, ects edema); angioneurotic (anaphylaxis, reactions Hypersensitivity purpura); thrombocytopenic agranulocytosis, neutropenia, eff Hematological esophagitis); (leukopenia, ects GI eff (N/V,ects discomfort, abdominal diarrhea, • • Apply needed 6-12 hrly oras Wash required as Remarks Administration © MIMS 2019

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