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  • Image not available. Folliculitis, furuncles (boils), and carbuncles begin around hair follicles and are caused most often by Staphylococcus aureus. Folliculitis and small furuncles are generally treated with warm, moist heat to promote drainage; large furuncles and carbuncles require incision and drainage. A penicillinase-resistant penicillin such as dicloxacillin is commonly used for extensive or serious infections (e.g., fever). Empiric treatment of purulent infections that have a high suspicion for community-associated methicillin-resistant S. aureus (CA-MRSA) should include clindamycin, trimethoprim–sulfamethoxazole, a tetracycline, or linezolid.
  • Image not available.Erysipelas, a superficial skin infection with extensive lymphatic involvement, is caused by Streptococcus pyogenes. The treatment of choice is penicillin, administered orally or parenterally, depending on the severity of the infection.
  • Image not available.Impetigo is a superficial skin infection that occurs most commonly in children. It is characterized by fluid-filled vesicles that develop rapidly into pus-filled blisters that rupture to form golden-yellow crusts. Effective therapy includes penicillinase-resistant penicillins (dicloxacillin), first-generation cephalosporins (cephalexin), and topical mupirocin. S. aureus is the primary cause of impetigo, with infections caused by CA-MRSA emerging in recent years.
  • Image not available.Lymphangitis, an infection of the subcutaneous lymphatic channels, is generally caused by S. pyogenes. Acute lymphangitis is characterized by the rapid development of fine, red, linear streaks extending from the initial infection site toward the regional lymph nodes, which are usually enlarged and tender. Penicillin is the drug of choice.
  • Image not available.Cellulitis is an infection of the epidermis, dermis, and superficial fascia most commonly caused by S. pyogenes and S. aureus. Lesions generally are hot, painful, and erythematous, with nonelevated, poorly defined margins. Oral trimethoprim–sulfamethoxazole, doxycycline, minocycline, or clindamycin is used for initial treatment of suspected CA-MRSA in patients with purulent cellulitis (i.e., lesion with purulent drainage or exudate, or nondrainable abscess). Treatment of nonpurulent cellulitis generally consists of a penicillinase-resistant penicillin (dicloxacillin) or first-generation cephalosporin (cephalexin) for 5 to 10 days, with the option of adding coverage for CA-MRSA in certain patients. Severe infections in hospitalized patients should receive empiric therapy with vancomycin.
  • Image not available.Necrotizing fasciitis is a rare but life-threatening infection of subcutaneous tissue that results in progressive destruction of superficial fascia and subcutaneous fat. Early and aggressive surgical debridement is an essential part of therapy for treatment of necrotizing fasciitis. Mixed infections are treated with broad-spectrum regimens that cover streptococci, gram-negative aerobes, and anaerobes. Infections caused by S. pyogenes or Clostridium species should be treated with the combination of penicillin and clindamycin.
  • Image not available. Diabetic foot infections are managed with a comprehensive treatment approach that includes both proper wound care and antimicrobial therapy. Potential pathogens include staphylococci, streptococci, aerobic gram-negative bacilli, and obligate anaerobes. Antimicrobial regimens for diabetic foot infections are based on severity of the infection, expected treatment setting, and risk factors for infection with more resistant pathogens such as methicillin-resistant S. aureus (MRSA) and Pseudomonas aeruginosa. Outpatient therapy with oral antimicrobials should be used whenever possible for less severe infections, while more severe infections initially require IV therapy.
  • Image not available. Prevention is the single most important aspect in the management of pressure sores. ...

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