Pharmacologic Treatment

Antibiotic therapy is recommended to achieve the desired outcomes of preventing the spread of infection and complications. Because GAS historically has been the primary causative organism, penicillin has been the mainstay of therapy. However, the incidence of S. aureus impetigo is increasing, so oralpenicillinase-stable penicillins or first-generation cephalosporins are now preferred. Clindamycin or a macrolide are alternative choices when penicillin allergy is a concern; however, the clinician should be aware that some strains of GAS and S. aureus may be resistant to macrolides. Topical mupirocin may be used alone when there are few lesions.1

Table 73-1 Folliculitis, Furuncles, and Carbuncles

Follls ulitii



£ pKkroiQtogy/


Presenwüon and diagnosis

O FotlKuliri is a uipertxial infiommaroiy tMakiiHiMM/^ihttalihNldt rPwiiKHf /amiftjj farm of foSHiulurt H OtJIf. h can be inifn 1K/J1. caused by microorganisms «a h ¿S Stapl^ioiXCC^aint^Pillldomonti, jntj ("ortfrti. follfc-uliti^ canals bechemKally-ind kined follicular piesems JS small. pruritic, erylhemaloits papules. Ictalnn -of the tiiofti and a<iood patient history ofien all th.ii Are W|uiiert m the diagnosis of fohtulitis. '■Vtiilc Gram slain and Culture of The (Hpul« may fce comidered » help determine the causative agenl, they aie not generally leawed as loHicd In is typically r«oifS spsnwneoosjy

Also kivMnas hmls.fuiuixb>s mitjhr be descnEed as a deep form of folliculitis. A. fuiufKit iv a bjtwiijl ¡nfMlififi thai lus spread inlo Ihe sJicutanfiius skin layers but still only Involves ¡ hJliUis f uruncti0*.CU primarily In young mm fHabete1. and obesity are other predisposing iactors. fcaphykxoco are the m«t (won cause furuncles moil commonly develop on ('te face, neck, amlla, and buttock Muiuncfc lypitalv STJrTi as i imalt red-n^nrter nodule. Within a few days, (he nodule becomes fwml n i and [HJSTular, TypiMBy.i ful^ocle iptxiMrenu^'y discharge pus, heal and leave a sinai scar

(aitsum l«shiie .ill (1^ characteristics of furuncles. Huwtvrr.j (jiburtclt1 Is La<ger and Inwlies sever jl adjacent follicles mjy Ofltrrf into ■he mbculaneous f.U. Carbuncles are more likL V (0 OCtui in I urn 'ins ivll h diabelPi, and lend to form Onlhebdikof therroii taibunclesare SimiMn 10 IYii uncles, 0*4y [hey jig Uiyer and exqufciwty psinftil

Desired ourcomes

MunpfuiniatolDg* tiftiniwHii

Rhjrmxotogic creatine

The goals of therapy for follicutnts, ftnunrlei,andc.aibunrlesare rpsoJutlon of infection with no c mlnmal scaring. A sccondiiy gun of therapy for iurunci« and an cjrburiiics is to «laiämije (he rü of ordocartHis or ivsrmiYiyeliiL«. t5y reducing bloodstream invasion

© O/ttn jfsohofi ipootflfBHji^. A fopicaf antiiraiK or UntifungoS may be ujnJio ¿(JrifM It«.1- jp.Wki (it Intel*yt fur iji/kvdty-«iivinetessary. For sJaphyto: octal or strspHscoee*) roiiitumis. jrnitÄjiitoiwirKMiis such as muplrocin might be adminlsnerfd

Itvee times daily. Antifungal sliampoocan be used for dermwtofXws

Mrnf toot«indented to faottoli Incmon and drainage are

(rtflii fligt jfalilJr'h;'Hh; tfVitri» inrt*'ifiV.

and drainage

COttWK)» Gftjitllutxlcf riw iwi' StirJOorKlir^ (etkjtlii JrVj Jfw1 or ate located midline on the face musf be rrenieil iysremica'iy iv.fh an onntvcXt rhji nvniiPHTJ^taph^ticijctiJS juietni mth is dictmoi imn iV ctfihet&tln, Jt'MinhGpHift dcaiiyfli/H. <n cl.ffdamycln aie preferred if L~A-\tftiA ft su^perr«? or if ihepofeni hos OKWtoHeiwHitvnK'Hii'. Tiejiinent should c«Hi"ue unlilnnule ■nil.imnuiii^r' h.w resolwd. usually a to I D-day -couree

Fran Fiefs l.&ll.

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