Ecthyma Treatment
Ecthyma should be treated with an oral antimicrobial. [1]
Diagnostic Evaluation Before Therapy
Gram stain and culture of pus or exudate from ecthyma lesions are recommended to identify whether Staphylococcus aureus and/or β-hemolytic streptococci is the cause. [1]
Treatment without these studies is reasonable in typical cases. [1]
Antibiotic Selection for Oral Therapy
A 7-day oral regimen should use an agent active against S. aureus unless cultures yield streptococci alone. [1]
Because S. aureus isolates from impetigo and ecthyma are usually methicillin susceptible, dicloxacillin or cephalexin is recommended. [1]
If MRSA is suspected or confirmed, doxycycline, clindamycin, or trimethoprim-sulfamethoxazole (SMX-TMP) is recommended. [1]
When cultures yield streptococci alone, oral penicillin is the drug of choice. [1]
Duration of Therapy
Oral therapy for ecthyma should be a 7-day regimen. [1]
Topical Therapy Role
Topical therapy should not be used as the sole treatment for ecthyma. [1]
Special Circumstances
Systemic antimicrobials should be used for infections during outbreaks of poststreptococcal glomerulonephritis to help eliminate nephritogenic strains of Streptococcus pyogenes from the community. [1]
Prognosis and Clinical Course
Ecthyma heals as a deeper infection than impetigo and is associated with scarring. [1]
Common Pitfalls to Avoid
Treatment of ecthyma with topical therapy alone is a common failure mode because ecthyma requires systemic antimicrobial therapy. [1]
Incomplete antimicrobial coverage is a common failure mode because oral therapy for ecthyma should cover S. aureus and streptococci unless cultures identify streptococci alone. [1]