Skin infections

Summary of changes

Addition 

  • Added common concurrent skin conditions
  • Defined boil, carbuncle, abscess

Medicines 

  • For boils: antibiotic only for severe or other specified conditions
  • For cellulitis: trimethoprim-sulfamethoxazole added as first line antibiotic, removed phenoxymethylpenicillin
  • For severe cellulitis: added probenecid to cefazolin. Added re benzathine benzylpenicillin dose that if dose for RHD given in previous 7 days to do a medical consult
  • Regarding benzathine benzylpenicillin dose added that if dose for RHD given in previous 7 days a medical consult is required. National RHD guidelines note that: 'Individuals already receiving BPG secondary prophylaxis still need active treatment of sore throats or skin sores. This is necessary because the level of penicillin achieved by BPG wanes by about 7 days to reach a prophylactic level which is lower than a required treatment level
  • If the last BPG dose was 7 or more days ago, provide antibiotic dosing in accordance with Table for sore throat or Table for skin sores

Other

  • Boils — added drainage as first line treatment, antibiotic only for severe or other specified conditions

Primary references

  1. Bowen AC, Carapetis JR, Currie BJ, Fowler V Jr, Chambers HF and Tong SYC (2017) 'Sulfamethoxazole-Trimethoprim (Cotrimoxazole) for Skin and Soft Tissue Infections Including Impetigo, Cellulitis, and Abscess', Open Forum Infectious Diseases, 4(4):ofx232, doi:10.1093/ofid/ofx232

  2. Bowen AC, Tong SY, Andrews RM, O'Meara IM, McDonald MI, Chatfield MD, Currie BJ and Carapetis JR (2014) 'Short-course oral co-trimoxazole versus intramuscular benzathine benzylpenicillin for impetigo in a highly endemic region: an open-label, randomised, controlled, non-inferiority trial', Lancet, 384(9960):2132-40, doi:10.1016/S0140-6736(14)60841-2

  3. Everts RJ, Begg R, Gardiner SJ, Zhang M, Turnidge J, Chambers ST and Begg EJ (2020) 'Probenecid and food effects on flucloxacillin pharmacokinetics and pharmacodynamics in healthy volunteers', Journal of Infection, 80(1):42-53, doi:10.1016/j.jinf.2019.09.004

  4. Expert Groups for Antibiotic, version 16 (2021) Antibiotic, Therapeutic Guidelines, accessed 24 April 2022.

  5. Expert Groups for Antibiotic, version 16 (2022) Impetigo, Therapeutic Guidelines, accessed 12 November 2022.

  6. Hartantyo SHP, Chau ML and Fillon L (2018) 'Sick pets as potential reservoirs of antibiotic-resistant bacteria in Singapore', Antimicrobial Resistance and Infection Control, 7:106, doi:10.1186/s13756-018-0399-9

  7. Kassiri H, Fahdani AE and Cheraghian B (2021) 'Comparative efficacy of permethrin 1%, lindane 1%, and dimeticone 4% for the treatment of head louse infestation in Iran', Environment Science and Pollution Research International, 28(3):3506-3514, doi:10.1007/s11356-020-10686-3

  8. Miller LG, Eells SJ, David MZ, Ortiz N, Taylor AR, Kumar N, Cruz D, Boyle-Vavra S and Daum RS (2015) 'Staphylococcus aureus skin infection recurrences among household members: an examination of host, behavioral, and pathogen-level predictors', Clinical Infectious Diseases, 60(5):753-63, doi:10.1093/cid/ciu943

  9. Mumcuoglu KY, Pollack RJ, Reed DL, Barker SC, Gordon S, Toloza AC, Picollo MI, Taylan-Ozkan A, Chosidow O, Habedank B, Ibarra J, Meinking TL and Vander Stichele RH (2021) 'International recommendations for an effective control of head louse infestations', International Journal of Dermatology, 60(3):272-280, doi:10.1111/ijd.15096

  10. Rawla P, Padala SA and Ludhwani D (2021) Poststreptococcal Glomerulonephritis, StatPearls Publishing, Treasure Island.

Indigenous/remote context references

  1. Australian Healthy Skin Consortium (2018) National Healthy Skin Guideline for the Prevention, Treatment and Public Health Control of Impetigo, Scabies, Crusted Scabies and Tinea for Indigenous Populations and Communities in Australia (1st edition), accessed 5 October 2022.