Ecthyma Treatment Guidelines

Introduction to Ecthyma

Ecthyma presents as vesicles that rupture, resulting in circular, erythematous ulcers with adherent crusts, often with surrounding erythematous edema, and heals with scarring, according to the Infectious Diseases Society of America 2

Cultures of the vesicle fluid, pus, erosions, or ulcers should be obtained to establish the causative organism, as recommended by the Infectious Diseases Society of America 2
Gram stain and culture of pus are recommended to guide targeted therapy, according to the Infectious Diseases Society of America 1

For presumed methicillin-susceptible S. aureus (MSSA), the American Academy of Pediatrics recommends dicloxacillin or cephalexin for 7 days 1
When MRSA is suspected or confirmed, the Infectious Diseases Society of America recommends doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMX-TMP) 1
For patients with streptococci alone, the American Academy of Pediatrics recommends penicillin as the drug of choice, or a macrolide or clindamycin for penicillin-allergic patients 2

Oral antibiotic therapy should be continued for 7 days, as recommended by the Infectious Diseases Society of America 1
The recommended duration for most bacterial skin and soft tissue infections is 7-14 days, according to the Infectious Diseases Society of America 4

Systemic antimicrobials should be used during outbreaks of poststreptococcal glomerulonephritis to eliminate nephritogenic strains of S. pyogenes, as recommended by the Infectious Diseases Society of America 1
In areas with high MRSA prevalence, empiric therapy should cover MRSA until culture results are available, according to the Infectious Diseases Society of America 3