Treatment of Infectious Diseases

Fungal Diseases Dr. Rafal Al-Saigh
1
Treatment of Infectious Diseases
Skin & Soft tissue infections
There are range from furuncles and carbuncles to necrotizing fasciitis; in
addition to erysiplelas, cellulitis & abscess.
1. Erysipelas: painful, superficial, erythematous, sharply demarcated
lesion that is usually found on lower extremities; caused by S.
pyogenes, less commonly S. aureus & Klebsiella. Treatment: Penicillin
or Macrolides & clindamycin are also appropriate.
2. Cellulitis: inflammation and infection of skin and underlying soft tissue,
superficial to fascia. S. pyogenes and S. aureus are most common
causative agents & less commonly S. pneumoniae & Haemophilus
influenzae (head & neck). Treatment: Oxacillin or cefazolin as
Pencillinase RP. Vancomycin in CA-MRSA. Alternatively macrolides or
clindamycin. Treatment of associated infection with tinea pedis by
topical antifungals. Linezolid (A member of the oxazolidinone drugs)
should also be considered (with Gram +ve infections). Hospital
admission in systemic toxicity & promote drainage of the inflammation.
3. Abscess: a localized collection of pus resulting from the disintegration
of tissue in the dermis and deeper skin tissues may be associated with
fever. Incision and drainage is the key to treatment. Cultures &
antibiotics suspetibility are necessary for immunocompromised
patients. Hospital admission considered with large abscesses (>5cm) or
signs of systemic toxicity. MRSA (most causative agent) is susceptible to
clindamycin, doxycycline, macrolides, fluoroquinolones, vancomycin
and linezolid.
4. Necrotizing fasciitis: a subcutaneous infection involves the deep layer
of superficial fascia with high mortality, manifested by extensive softtissue
infection and thrombosis of the microcirculation with resulting
necrosis. S. pyogenes, or Staph species, Clostridium, Pseudomonas,
and fungal organisms & mostly mixed. Supportive care & surgical
exploration with IV Antibiotic treatment include penicillin,
clindamycin, fluoroquinolones and aminoglycosides are important
measures of management.