Treatment of erysipelas

Etiotropic treatment of erysipelas

Treatment of erysipelas under the conditions of a polyclinic passes with the appointment of one of the antibiotics listed below: azithromycin - on the first day of 0.5 g, then for 4 days - 0.25 g once a day (or 0.5 g in for 5 days); spiramycin - 3 million ME twice a day; roxithromycin - 0.15 g twice daily: levofloxacin - 0.5 g (0.25 g) twice a day; cefaclor - 0.5 g three times a day. The course of treatment is 7-10 days. With intolerance to antibiotics, chloroquine is administered 0.25 g twice daily for 10 days.

In a hospital, treatment of erysipelas is performed with benzylpenicillin at a daily dose of 6 million units by intramuscular injection for 10 days.

Preparations of the reserve - cephalosporins of the first generation (cefazolinum in a daily dose of 3-6 g or more intramuscularly for 10 days and clindamycin in a daily dose of 1.2-2.4 g and more intramuscularly). These drugs are usually prescribed for severe, complicated erysipelas.

In case of severe erysipelas, the development of complications (abscess, phlegmon, etc.), it is possible to combine benzylpenicillin (at the indicated dose) and gentamicin (240 mg once a day intramuscularly), benzylpenicillin (in this dosage) and ciprofloxacin (800 mg intravenously) , benzylpenicillin and clindamycin (in the indicated doses). It is justified the appointment of combined antibacterial therapy with a bullous-hemorrhagic erysipelas with abundant effusion of fibrin. With these forms of the disease, other pathogenic microorganisms beta-hemolytic streptococci of groups B, C, D, G are often isolated from the local inflammatory focus; Staphylococcus aureus, Gram-negative bacteria).

[1]

Pathogenetic treatment of erysipelas

With severe infiltration of the skin in the focus of inflammation shows the intake of NSAIDs (diclofenac, indomethacin) for 10-15 days. For severe erysipelas, parenteral detoxification treatment for erysipelas (polyvidone, dextran, 5% glucose solution, polyionic solutions) is performed with the addition of 5-10 ml of a 5% solution of ascorbic acid, 60-90 mg of prednisolone. Assign cardiovascular, diuretic, antipyretics.

Pathogenetic treatment of erysipelas, namely local hemorrhagic syndrome, is effective in early treatment (in the first 3-4 days) treatment, when it prevents the development of extensive hemorrhages and bulls. The choice of the drug is carried out taking into account the coagulogram data. With severe hypercoagulation, treatment with heparin sodium is indicated (subcutaneous injection at a dose of 10-20 thousand units or 5-7 procedures of electrophoresis), pentoxifylline 0.2 g three times a day for 2-3 weeks. In the absence of hypercoagulation, it is recommended to administer directly to the inflammatory focus by electrophoresis of the protease inhibitor-aprotinin (course of treatment 5-6 days).

Treatment of patients with recurrent erysipelas

Treatment of erysipelas of this form is carried out in a hospital. It is mandatory to assign reserve antibiotics that have not been used in the treatment of previous relapses. Assign cephalosporins of the first generation intramuscularly ps 0.5-1 g 3-4 times a day. The course of antibacterial therapy - 10 days. With a frequently recurring erysipelas, a 2-course treatment is advisable. First, antibiotics are prescribed, optimally acting on bacterial forms and L-forms: streptococcus. Thus, for the first course of antibiotic therapy, cephalosporins (10 days) are used, after a 2-3-day break, a second course of treatment with lincomycin is administered - 0.6 g three times a day intramuscularly or 0.5 g oral three times a day (7 days). With a recurring face, immunocorrective therapy is indicated (methyluracil, sodium nucleic acid, prodigiosan, thymus extract, azoxime bromide, etc.). It is expedient to study the immune status in dynamics.

Local treatment of erysipelas is performed with a bullous form of erysipelas with localization of the process on the limbs. The erythematous form of erysipelas does not require the use of local remedies (bandages, ointments), and many of them are contraindicated (ihtamol, Vishnevsky ointment ointments with antibiotics). Intact blisters carefully cut at one of the edges and after exudate exude dressings with 0.1% ethacridine solution or 0.02% solution of furacilin, changing them several times a day. Tight bandaging is unacceptable. With extensive erosion of erosion, local treatment starts with manganese baths for the limbs and subsequently apply the above dressings. To treat local hemorrhagic syndrome with erythematous hemorrhagic erysipelas, 5-10% liniment of butylhydroxytoluene (twice a day) or 15% aqueous solution of dimephosphone (five times a day) in the form of applications for 5-10 days is used.

Additional treatment of erysipelas

In the acute period of erysipelas, suberitem doses of ultraviolet irradiation are traditionally prescribed to the area of inflammation and exposure to ultra-high frequency currents to the region of regional lymph nodes (5-10 procedures). If during the convalescence period, skin infiltration, edematous syndrome remain. Regional lymphadenitis, ozokerite applications or bandages with heated naftalan ointment (on the lower limbs), paraffin applications (on the face), lidase electrophoresis (especially in the initial stages of elephant formation), calcium chloride, radon baths, magnetotherapy.

In recent years, high efficiency of low-intensity laser therapy has been established in the treatment of local inflammatory syndrome with various clinical forms of erysipelas. The normalizing effect of laser radiation on altered hemostatic parameters in patients with hemorrhagic erysipelas was noted. Usually, a combination of high and low frequency laser radiation is used in one procedure. In the acute stage of the disease (with pronounced inflammatory edema, hemorrhages, bullous elements) laser radiation of low frequency is used, in the stage of reconvalescence (to enhance the reparative processes in the skin) - high-frequency laser radiation. The duration of exposure to one radiation field is 1-2 minutes, and the duration of one procedure is 10-12 minutes. If necessary, before the laser therapy (in the first days of treatment), treat the inflammation focus with a solution of hydrogen peroxide to remove necrotic tissues. Course of laser therapy 5-10 procedures. Beginning with the second procedure, laser action (using infrared laser therapy) on the projection of large arteries, regional lymph nodes is performed.

Bicillin prophylaxis for recurrences of erysipelas is an integral part of complex treatment of patients suffering from recurrent form of erysipelas. Prophylactic intramuscular injection of bicillin-5 (1.5 million units) or benzylatin benzylpenicillin (2.4 million units) prevents recurrence of the disease associated with reinfection with streptococcus. With the preservation of foci of endogenous infection, these drugs prevent the reversal of L-forms of streptococcus into the original bacterial forms, which helps prevent recurrence. For 1 hour before the introduction of bicillin-5 or benzathine benzylpenicillin recommend the appointment of antihistamines (chloropyramine, etc.).

With frequent relapses (at least three in the last year), a method of continuous (year-round) bicillin prophylaxis is recommended for one year or more with a 3-week interval of drug administration (in the first months the interval can be shortened to 2 weeks). With seasonal relapses, the drug is administered 1 month before the start of the incidence season in a patient with a 3-week interval for 3-4 months per year. In the presence of significant residual effects after the transferred erysipelas, the drug is administered at an interval of 3 weeks for 4-6 months.

[2], [3], [4], [5], [6], [7],

Diet in the face

The regime depends on the severity of the current. Diet: a common table (No. 15), plentiful drink. In the presence of concomitant pathology (diabetes mellitus, kidney disease, etc.), the appropriate diet is prescribed.

[8], [9], [10], [11],

Approximate terms of incapacity for work

Inpatient and outpatient treatment of erysipelas lasts 10-12 days with a primary, uncomplicated erysipelas and up to 16-20 days - with a severe, recurrent erysipelas.

Clinical examination

Clinical examination is performed for patients:

• with frequent, at least three in the last year, recurrence of erysipelas:
• with a pronounced seasonal nature of relapses:
• with prognostically unfavorable residual events at discharge from the department (increased regional lymph nodes, persistent erosion, infiltration, puffiness of the skin in the focus area, etc.).

Terms for clinical examination are determined individually, but they should be at least one year after the disease, with a period of inspection at least once every 3-6 months.

Rehabilitation of patients who have suffered an erysipelas (especially with a recurring course, the presence of background diseases), includes two stages.

The first stage is the period of early convalescence (immediately after discharge from the specialized department). At this stage, depending on the patient's condition, they recommend:

• paraffin and ozokeritotherapy:
• laser therapy (mainly in the infrared range);
• magnetotherapy:
• high-frequency and ultra-high-frequency electrotherapy (according to indications);
• local darsonvalization;
• ultra-high-frequency therapy;
• electrophoresis with lidase, iodine, calcium chloride, sodium heparin, etc .;
• radon baths.

The necessary treatment for erysipelas is differentiated, taking into account the age of the patients (60-70% of all cases - people over 50), the presence of severe concomitant somatic diseases,

An important factor that must be taken into account in carrying out rehabilitation measures is the presence of skin fungal diseases in most patients. In this regard, an essential element of complex rehabilitation after the transferred face - therapy of fungal diseases of the skin.

Treatment of erysipelas can be performed against the background of bicillin prophylaxis.

The second stage is the period of late convalescence.

Depending on the condition of the patient, the presence of background diseases in this period, you can use the above complex of physiotherapy procedures. Periodicity of rehabilitation courses (1-2 times or more per year) is determined by the doctor.

[12], [13], [14], [15], [16],

Memo for the patient

It is desirable to change the lifestyle: avoid unfavorable working conditions associated with frequent overcooling, sudden changes in air temperature, dampness, drafts; micro-traumas of the skin and other occupational hazards; to avoid stress.

To prevent the recurrence of the disease (on an outpatient basis or in specialized departments under the supervision of a specialist doctor) it is recommended:

• timely and complete antibiotic therapy of primary disease and relapses;
• treatment of severe residual effects (erosion, persistent swelling in the local hearth), the consequences of erysipelas (persistent lymphostasis, elephantiasis);
• treatment of long and persistent chronic skin diseases (mycoses, eczema, dermatosis, etc.). Leading to a violation of its trophism and serving as input gates for infection:
• treatment of foci of chronic streptococcal infection (chronic tonsillitis, sinusitis, otitis, etc.);
• treatment of lymph and blood circulation disorders in the skin, resulting from primary and secondary lymphostasis, chronic peripheral vascular disease;
• treatment of obesity, diabetes mellitus (frequent decompensation of which is observed in the face).

What forecast does the face have?

The erysipelas have a favorable prognosis, if treatment of erysipelas is started in a timely manner. However, in persons with severe concomitant diseases (diabetes mellitus, cardiovascular insufficiency), a fatal outcome is possible.