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SOURCE

Source: Fish DN. Skin and soft-tissue infections. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146071658. Accessed July 21, 2017.

CONDITION/DISORDER SYNONYM

  • Saint Anthony’s fire.

DEFINITION

  • Infection of superficial layers of skin and cutaneous lymphatics.

ETIOLOGY

  • Caused by β-hemolytic streptococci with Streptococcus pyogenes (group A streptococci), responsible for most infections.

PATHOPHYSIOLOGY

  • Organisms gain access via small breaks in skin.

EPIDEMIOLOGY

  • Infections common in infants, young children, elderly, and patients with nephrotic syndrome.

  • Commonly occurs in areas of preexisting lymphatic obstruction or edema.

RISK FACTORS

  • Preexisting lymphatic obstruction or edema.

  • Nephrotic syndrome.

CLINICAL PRESENTATION

  • Lower extremities most common sites.

SIGNS AND SYMPTOMS

  • Flu-like symptoms (fever and malaise) prior to appearance of lesions.

  • Infected area painful, often described as burning pain.

  • Lesions bright red and edematous, with lymphatic streaking.

  • Mild temperature elevation.

DIAGNOSIS

MEANS OF CONFIRMATION AND DIAGNOSIS

  • Made on the basis of characteristic lesion.

LABORATORY TESTS

  • Complete blood count (CBC): leukocytosis common.

  • C-reactive protein generally elevated.

  • Cultures.

    • Causative organism usually cannot be cultured.

    • Consider with more severe case or atypical findings such as fluid-filled blisters.

DESIRED OUTCOMES

  • Rapid eradication of infection.

TREATMENT: PHARMACOLOGIC THERAPY

TABLE 1.Evidence-Based Recommendations for Treatment of Skin and Soft-Tissue Infections
TABLE 2.aRecommended Drugs and Dosing Regimens for Outpatient ...

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