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Description:

Erysipelas or erysipelas is a serious infectious disease, the external manifestations of which are damage (inflammation) of the skin of a hemorrhagic nature, an increase in temperature and the phenomenon of endotoxicosis.
The name of the disease comes from the French word rouge, which translates as “red.”
Erysipelas is a very common infectious disease, statistically ranking 4th, second only to intestinal infections and infectious hepatitis. Erysipelas is most often diagnosed in patients of older age groups. Between the ages of 20 and 30, erysipelas affects mainly men, whose professional activities involve frequent microtrauma and skin contamination, as well as sudden changes in temperature. These are drivers, loaders, builders, military, etc. In the older age group, most of the patients are women. The localization of erysipelas is quite typical - in most cases, inflammation develops on the skin of the upper and lower extremities, less often on the face, and even less often on the torso, perineum and genitals. All these inflammations are clearly visible to others and cause the patient a feeling of acute psychological discomfort.
Erysipelas are widespread. Its incidence in various climatic zones of our country is 12-20 cases per 10 thousand population per year. Currently, the percentage of erysipelas in newborns has decreased significantly, although previously this disease had a very high mortality rate.

Causes:

The causative agent of erysipelas is group A beta-hemolytic streptococcus, which can be present in the human body in active and inactive, so-called L-form. This type of streptococcus is very resistant to environmental influences, but dies when heated to 56 C for half an hour, which is of great importance in antiseptics. Beta-hemolytic streptococcus is a facultative anaerobe, i.e. can exist both in oxygen conditions and in oxygen-free environments.
If a person suffers from any disease of streptococcal etiology, or is simply a carrier of this microorganism in any form, he can become a source of infection. According to statistics, about 15% of people are carriers of this type of streptococcus, and they do not have any clinical signs of the disease. The main route of transmission of the pathogen is through household contact. Infection occurs through damaged skin - in the presence of abrasions, abrasions, etc. Airborne transmission plays a less significant role in the transmission of infection (especially when erysipelas occurs on the face). Patients are less contagious.

The occurrence of erysipelas infection is facilitated by predisposing factors, for example, persistent lymph circulation disorders, prolonged exposure to the sun, chronic venous insufficiency, fungal skin diseases, stress factors. Erysipelas is characterized by summer-autumn seasonality.
Very often, erysipelas occurs against the background of concomitant diseases: foot fungus, alcoholism, lymphostasis (problems with lymphatic vessels), foci of chronic streptococcal infection (with erysipelas of the face,; with erysipelas of the extremities), chronic somatic diseases that reduce general immunity (more often in old age ).

Pathogenesis:

They classify primary, repeated (with a different localization of the process) and recurrent erysipelas. According to its pathogenesis, primary and recurrent erysipelas are acute streptococcal infections. The exogenous nature of the infection and the cyclical course of the infectious process are characteristic. These pathogens are found in the lymphatic capillaries of the papillary and reticular layers of the dermis, where a focus of infectious-allergic inflammation of a serous or serous-hemorrhagic nature occurs. In the implementation of inflammation, immunopathological processes play a significant role with the formation of immune complexes in the dermis, incl. and perivascular. Recurrent erysipelas is a chronic streptococcal infection, with the formation of characteristic endogenous foci in the skin and regional lymph nodes. In this case, a mixed infection of the body of patients with bacterial and L-form streptococci is observed. The L-form persists for a long time in the inter-relapse period of the disease in skin macrophages and organs of the macrophage system. With recurrent erysipelas, there is a severe violation of the immune status of patients, their sensitization and autosensitization.
It was also noticed that erysipelas most often occurs in people with III (B) blood group. Obviously, a genetic predisposition to erysipelas reveals itself only in old age (more often in women), against the background of repeated sensitization to group A beta-hemolytic streptococcus and its cellular and extracellular products (virulence factors) in certain pathological conditions, including those associated with involution processes.

Symptoms:

Based on the nature of clinical manifestations, erysipelas is divided into several forms:  
- erythematous
- erythematous-bullous
- erythematous-hemorrhagic
- bullous-hemorrhagic form.

The incubation period ranges from several hours to 3-5 days.
Based on the severity of the disease, mild, moderate, and severe forms are distinguished. Most often, the inflammatory process manifests itself on the lower extremities, less often on the face, upper extremities, and very rarely in the torso and genital area. The onset of the disease is acute, with a feeling of heat, general weakness, and muscle pain. There is a critical increase in the patient's body temperature to fibril levels - 38-39.5°. Often the onset of the disease is accompanied by. Very often, the described phenomena develop a day before skin manifestations.
The main sign of erysipelas is skin manifestations in the form of erythema with uneven edges clearly demarcated from unaffected skin in the form of a sinuous line, arcs and tongues, which are often compared to “tongues of flame.”

Erythematous erysipelas is characterized by the presence of a peripheral ridge in the form of a raised edge of erythema. The skin in the area of ​​erythema has a bright red color; upon palpation, pain is usually insignificant, mainly along the periphery of the erythema. The skin is tense and hot to the touch. At the same time, swelling of the skin is characteristic, which extends beyond the erythema. Regional is noted.

With erythematous-bullous erysipelas, blisters (bullas) appear against the background of erythema. The contents of the bullae are a transparent yellowish liquid.
With erythematous-hemorrhagic erysipelas, hemorrhages of various sizes occur - from small punctate to extensive and confluent, spreading throughout the entire erythema. The blisters contain hemorrhagic and fibrinous exudate, but they may also contain predominantly fibrinous exudate, be flattened in nature and have a dense consistency upon palpation.

Mild erysipelas is characterized by mildly expressed symptoms, the temperature rarely rises above 38.5°, and a moderate headache may be observed. In severe cases of the disease, the temperature reaches 40°C or higher, and there are tremendous chills, vomiting, disturbances of consciousness, and meningeal syndrome (so-called meningismus). An increase in heart rate is observed, and hemodynamic parameters drop.  
The elevated temperature in patients lasts up to 5 days. Acute inflammatory changes in the lesion disappear within 5-7 days in case of erythematous erysipelas, up to 10-12 days or more in bullous-hemorrhagic erysipelas. Enlarged regional lymph nodes that persist during recovery, skin infiltration at the site of inflammation, and low-grade fever are prognostically unfavorable for the development of early relapses.
Repeated erysipelas occurs 2 years or more after the previous illness and has a different localization.

Recurrent erysipelas is most often observed when the source of inflammation is localized in the lower extremities. There are predisposing factors for the transition of primary erysipelas to recurrent ones, in particular with concomitant chronic skin diseases, especially fungal ones (athlete's foot, rubrophytosis), previous lymphostasis, and the presence of foci of chronic streptococcal infection. Relapses develop over a period of several days and weeks to 1-2 years, their number can reach several dozen. Frequent relapses lead to severe disturbances in the lymphatic system.
Complications are usually local in nature: skin necrosis, abscesses, thrombophlebitis, lymphangitis, periadenitis. With concomitant severe diseases and late treatment, infectious-toxic shock may develop. With frequent relapses, lymphatic edema (lymphedema) and secondary edema are possible.

Treatment:

For treatment the following is prescribed:

Treatment for erysipelas is in most cases carried out at home or on an outpatient basis. Patients are advised to drink plenty of fluids and eat a balanced diet. Indications for hospitalization are severe disease, widespread local process, its bullous-hemorrhagic nature and recurrent erysipelas.

The main pathogenetic therapy for erysipelas is the prescription of antibiotics. Most often, one of the following antibacterial agents is used: oletethrin 0.25 g 4-6 times a day, metacycline hydrochloride 0.3 g 2-3 times a day, erythromycin or oleandomycin phosphate in daily doses of up to 2 g, combined chemotherapy drug bactrim (biseptol), sulfatone - 2 tablets 2 times a day in the morning and evening after meals. In a hospital setting and in severe cases of the disease, intramuscular administration of benzylpenicillin is indicated; for recurrent erysipelas - cephalosporins (cefazolin, claforan, etc.), lincomycin hypochloride. The duration of taking antibiotics is 8 - 10 days. Pathogenetic treatment also includes non-steroidal anti-inflammatory drugs, ascorutin to strengthen the vascular wall, and a complex of vitamins. For frequent relapses of the disease, nonspecific stimulating and immunocorrective therapy (pentoxyl, methyluracil, sodium nucleinate), as well as prodigiosan, levamisole, is indicated. The last two drugs are prescribed only in the hospital. With the recurrent nature of the disease, autohemotherapy is used in some cases.
Local treatment of erysipelas is carried out only in cases of bullous forms and localization of the process on the extremities. The blisters are incised at one of the edges and bandages with a solution of ethacridine lactate (1:1000) or furatsilin (1:5000) are applied to the site of inflammation, changing them several times a day. Subsequently, dressings with ectericide, vinylin, are used. In the acute period of the disease, physiotherapy can be used: UV irradiation and UHF therapy, and after the acute inflammatory process subsides, dressings with naphthalan ointment, applications with paraffin and ozokerite, radon baths, electrophoresis of lidase or calcium chloride to prevent persistent lymphostasis. Patients are discharged no earlier than the 7th day after body temperature normalizes. Those who have had erysipelas are registered in the office of infectious diseases for 3 months, and those suffering from recurrent erysipelas for at least 2 years.
Surgical treatment of complications in erysipelas. When developing, the patient undergoes necrectomy after stabilization of the general condition. The wound is covered with dalcex-trypsin with an antiseptic, teralgin, algipor, hydrophilic ointment (levomekol) or chemotherapeutic agents (dimexide, iodopirone, etc.). For large defects, after the appearance of dense granular granulations and the elimination of acute phenomena, a repeat operation is performed - autodermoplasty, the meaning of which is to close the skin defect, with the patient himself becoming the donor and recipient. For phlegmon and abscesses, the incision is made along the shortest path, the skin and subcutaneous tissue are dissected and the abscess cavity is opened. After evacuation of the detritus, the cavity is washed with antiseptics, dried, the edges of the wound are separated with hooks and an inspection is performed. All non-viable tissues are excised. The wound, as a rule, is not sutured; a sterile bandage is applied. For purulent lymphadenitis, abscessing phlebitis and paraphlebitis and other foci of a purulent-inflammatory nature, surgical treatment is indicated - opening accumulations of pus, removing necrotic tissue, draining the wound.

Prevention:

Preventive measures to prevent the development of erysipelas include careful personal hygiene, preventing injuries and abrasions of the legs. If such an injury occurs, treatment with antiseptics is indicated (for example, a 5% alcohol solution of iodine, a solution of brilliant green). Timely sanitation of foci of chronic streptococcal infection is necessary. Prevention of recurrent erysipelas involves treatment of diseases predisposing to relapse (fungal skin infections, lymphovenous insufficiency). In some cases, drug prevention of erysipelas is justified. For frequent, persistent relapses, bicillin-5 is administered for prophylactic purposes at 1,500,000 units intramuscularly every 3-5 weeks. for two to three years. In cases of pronounced seasonality of relapses and with significant residual effects, it is recommended to prescribe bicillin-5 in preventive courses lasting 3-4 months.

Antibiotics for erysipelas are the main treatment, because, as is known, the disease is infectious in nature. However, what specific drugs are used in treatment? Where does erysipelas occur and how to fight it or even prevent this disease before it appears? You can get this, as well as other information about the treatment of erysipelas, from this article.

General idea of ​​the disease

Erysipelas (erysipelas) is an infectious and allergic disease that affects the skin, mucous membranes and lymphatic system. The cause of the disease is group A beta-hemolytic streptococcus. The name of the disease comes from the French word “rouge”, meaning “red”, because with erysipelas, a characteristic sign is the formation of red spots on the patient’s skin.

Erysipelas is one of the most common diseases caused by infections, right after respiratory and intestinal diseases. In addition, the patient, having recovered from erysipelas, runs the risk of encountering the manifestation of this disease again in the coming years.

In addition, medical scientists note with alarm that today most cases of erysipelas occur in a severe form, while the percentage of mild forms has decreased significantly. Up to a third of all cases of the disease are associated with impaired blood and lymph circulation. Antibiotics for erysipelas of the leg must be combined with drugs that normalize the circulation of fluids. There is also the possibility of developing severe complications of the disease, leading to death.

Erysipelas can affect a patient of any age and gender category, but most cases of the disease are observed among women over 50 years of age. There are also frequent cases of infection with streptococcus in infants, which subsequently also causes erysipelas. There are also statistical data suggesting a predisposition to erysipelas in people with blood group III.

Most often, the disease is transmitted through direct contact with an infected person through skin lesions - wounds, abrasions, etc. Also, if the pathogen is carried, the disease may enter the active phase after a pathological decrease in immunity.

The most common “targets” of the disease are the arms and legs, less often the face and head. The disease has several stages of development, each with its own distinctive signs, the main one of which is the appearance of an area of ​​redness protruding above the surface of healthy skin as a dense convex ridge.

Risk groups for erysipelas

Erysipelas most often occurs with a decrease in either general or local skin immunity. It can affect people who have undergone chemotherapy, suffer from immunodeficiency, or have undergone immunosuppressive treatment.

In addition, the “entry gate” for erysipelas can be thrombosis, foot fungus, bedsores, sunburn and chapping, abrasions and other injuries - in short, any violation of the integrity of the skin, opening the path to the blood and lymph for infections.

It is for this reason that it is important to promptly treat any skin lesions with an antiseptic and properly care for them throughout the healing period. It is also necessary to pay attention to care products: it is important that they do not dry out the skin and do not leave dryness and cracks, which can also become a factor of infection.

Symptoms and signs of the disease

Erysipelas develops very acutely, and often the patient can indicate a specific time, up to an hour, when the first symptoms appeared. The first symptoms are fever and severe chills. Fever lasts from 5 to 10 days.

10-20 hours after infection, the skin on the affected area turns red. Later, a dense ridge forms in the area of ​​redness, which clearly rises above the skin. Usually in this place the skin has an increased temperature, swelling, and may hurt. The roller lasts 7-10 days, and then peeling appears in its place.

During the course of the disease (especially in the first 5-7 days), the patient may experience nausea (sometimes ending with vomiting), muscle and joint pain, convulsions, delirium, and a strong rise in temperature. The affected area may experience severe swelling, a feeling of fullness, a burning sensation, as well as an enlargement of the lymph nodes and the affected area.

There are 3 forms of complicated course of the disease:

• Erythematous - hemorrhagic - accompanied by hemorrhages;
• Erythematous - bullous - accompanied by the appearance of vesicles with transparent contents;
• Bullous - hemorrhagic - with blisters filled with purulent or bloody contents.

In complicated forms of the disease, the risk of experiencing a relapse is much higher than in normal cases.

General principles of treatment

A dermatologist can determine the symptoms and treatment of the disease, so when the first symptoms occur, you should go to him for an initial appointment. In addition, specialists of other profiles can be involved in treatment - infectious diseases specialist, surgeon, immunologist, etc.

During the examination, the doctor questions and assesses the patient’s current condition, and also prescribes a number of laboratory tests. The main indicators are a general blood test and bacteriological examination, because the nature of the disease is infectious.

Treatment of erysipelas of the leg, arm or face is not much different. The patient is usually prescribed to take two groups of drugs: antibiotics and antihistamines. Treatment with antibiotics is necessary to eliminate the main cause of the disease - the causative agent of infection, while antihistamines are needed to reduce swelling and eliminate the consequences of intoxication of the body with waste products of bacteria.

Antibiotics for the treatment of erysipelas

The drugs of choice in the treatment of erysipelas are penicillin antibiotics. They can be changed to drugs of other groups if, as a result of bacteriological research, it was revealed that the strain of streptococci is resistant to penicillins. They have a bactericidal effect, destroying the outer shell of the bacterium and thereby causing its death. The main drugs used in the group are:

• Phenoxymethylpenicillin. It is produced under such trade names as Ospen, Kliatsil, Megacillin Oral, Velikombin, etc. Preferably used in the form of tablets or syrup (for children). The course of treatment is 5-7 days for primary erysipelas, and 9-10 days for recurrent inflammation.
• Benzylpenicillin. It is produced under the same trade name in the form of a powder for the preparation of an injection solution. The drug is injected directly into the affected area subcutaneously; the course of treatment ranges from a week to a month.
• Bicillin-5. It is a combined antibiotic that is preferable to treat patients prone to relapses - with immunodeficiency, hereditary predisposition, those who have suffered a severe form of erysipelas, etc. The drug is injected once a month for several years.

Another group of antibiotics used for erysipelas of the limbs or face are tetracyclines. These agents have a bacteriostatic effect, preventing the synthesis of new bacterial cells. Most often, drugs based on Doxycillin are used - they are produced under the trade names Doxibene, Vidoccin, Doxal, etc. The drugs are available in tablet form.

Levomycetin (Chloramphenicol) is another alternative to the penicillin series. It also has a bacteriostatic effect. The drug is produced under the same trade names. It is produced in various forms, which increases the breadth of its application.

- These are the most modern and least toxic of antibiotics. In low concentrations they have a bacteriostatic effect, and in high concentrations they have a bactericidal effect. The main drug from this group used for erysipelas is Erythromycin. It is available in tablets.

The choice of a specific antibiotic depends not only on the results of bacteriological examination, but also on the patient’s condition and individual response to medications.

Other drugs in the treatment of erysipelas

As already noted, in addition to antibiotics, such drugs as antiallergic drugs (Tavegil, Diazolin, Suprastin) are used in the treatment of erysipelas. They not only contribute to the rapid elimination of edema, but also to the resorption of infiltrate at the site of the lesion.

Nitrofurans and sulfonamides are groups of drugs that improve the effectiveness of penicillin, prevent the growth of bacteria and destroy them. In addition, immunomodulatory drugs are used to increase the patient's immune response: thymus preparations, biostimulants. Glucocorticoids, hormonal drugs that have a strong anti-inflammatory effect, are also used to treat erysipelas.

In addition to the mentioned remedies, a diet of natural ingredients (honey, walnuts, aloe, etc.) is used, which increases immunity, and the site of inflammation itself is regularly treated with antimicrobial drugs.

To prevent erysipelas, it is necessary, first of all, to maintain personal hygiene. Without the proliferation of bacteria, the occurrence of this disease is impossible - therefore, by maintaining cleanliness and caution when in contact with an infected person, you can significantly protect yourself.

Erysipelas of the leg often occurs due to varicose veins or thrombophlebitis, so it is necessary to treat these diseases in a timely manner. In addition, erysipelas on the leg can occur due to excessively tight clothing or shoes, so preference should be given to natural, well-ventilated fabrics and proportionate clothing.

Thus, adherence to hygiene measures and a healthy lifestyle can not only significantly prevent the development of the disease, but also prevent its reappearance.

Contents [Show]

Erysipelas is an infectious-allergic disease that spreads to the subcutaneous tissue. Inflammation develops with the introduction of group A streptococcal flora. Often after treatment, a relapse of erysipelas occurs - repeated symptoms appear within six months, in 10 cases out of 100 it ends with elephantiasis (pathology of the lymphatic system). It is impossible to cure erysipelas without antibiotics. These drugs are needed to stop the vital activity of streptococcal flora.

The affected areas are red or purple in color and are separated from the surrounding tissue by a convex ridge. Every day, the area of ​​inflammation increases to 2-2.5 cm. Itching and burning of the skin is accompanied by increased temperature, fever, nausea, turning into vomiting, muscle and joint pain. Most often, erysipelas is localized in the lower leg area, the provoking factor is varicose veins and its complication - thrombophlebitis.

What drugs help to quickly stop the activity of pathogenic microorganisms?

Treatment of erysipelas is carried out using the following drugs:

The course of treatment, dosage and frequency of administration depend on the severity of the disease, the age and weight of the patient, the chosen drug, as well as on the concomitant medical history.

Treatment of erysipelas on the leg with antibiotics is not available to everyone. Patients with a polyvalent allergy to antibacterial agents are prescribed the following therapeutic regimen to destroy streptococci: complex treatment with Furazolidone (a drug from the nitrofufan group with pronounced antimicrobial activity) and Delagil (a drug used to treat malaria, with the active ingredient chloroquine).

Hospitalization in a hospital is necessary if relapses of erysipelas occur every 2-3 months, the disease is severe, the patient has a history of diseases for which using antibiotics at home is extremely dangerous - if side effects occur, you may not wait for an ambulance. Inpatient treatment is recommended for patients under 3 years of age and those who are elderly. Patients are hospitalized in infectious diseases departments.

If at home antibiotics are taken in tablets, then in the hospital for the treatment of erysipelas they use the form of injections:

In case of a pronounced inflammatory process, therapeutic measures are supplemented - at home and in hospital - with anti-inflammatory drugs - Butadione or Chlotazol. The course of treatment is up to 2 weeks. Immunomodulators and vitamin complexes must be prescribed - they should be taken after the general symptoms have been eliminated for another month.

In severe cases of the disease, severe swelling of the legs - in order to prevent the development of lymphostasis - intravenous detoxification is carried out. In this case, infusion treatment is necessary: ​​“Reopoliglyukin”, “Hemodez”, solutions: 5% glucose and physiological. Sometimes Prednisolone is added to the drip.

It is customary to adhere to the following daily doses of antibacterial drugs:

• “Oletetrin” – 1 g/day;
• “Azithromycin” or “Erythromycin” – 2 g/day;
• metacycline hydrochloride – 1 g/day.

For recurrent erysipelas, antibiotics are administered only intramuscularly - cephalosporins (Claforan, Cefazolin), Lincomycin - up to 2 times a day.

To treat recurrent erysipelas, patients are hospitalized in a hospital. Antibiotics are prescribed that were not used in the original therapeutic regimen. In this case, the drugs are no longer prescribed in tablets, but only in injections - intramuscularly.

• week – 10 days – cephalosporins;
• week break;
• week – “Lincomycin”.

Additionally, diuretics and cytostatics are prescribed.

To eliminate skin inflammatory processes, topical agents are used. Treatment is symptomatic; ointments with antibacterial components are not used.

It is necessary to begin therapeutic measures when the first signs of the disease appear. If erysipelas occurs in a mild form, then the symptoms of the disease subside within 3 days and no changes remain on the skin of the legs. In severe cases of erysipelas, there is a high probability of developing complications - gangrene, sepsis, streptococcal pneumonia. The mortality rate from this disease currently remains at 5%.

Swelling of the legs, redness of the skin and pain to the touch - if these symptoms appear, you should consult a doctor. No home methods will stop the development of the inflammatory process.

Erysipelas is an infectious disease accompanied by damage to the skin, mucous membranes and lymphatic system, caused by group A beta-hemolytic streptococcus.

Etiotropic therapy

When treating streptococcal skin lesions, preference is given to drugs with a bactericidal effect.

Penicillins, sulfonamides and fluoroquinolones have maximum activity against beta-hemolytic streptococci.

For mild forms of erysipelas, macrolides and lincosamides are used.

Penicillins

Benzylpenicillin

"Gold standard" of treatment.

Natural penicillins have a pronounced bactericidal effect on streptococcal flora. They have low toxicity and affordable cost.

Used intramuscularly. Not effective when taken orally (destroyed in the gastrointestinal tract).

Adults are prescribed 500 thousand units up to six times a day, for a course of up to 10 days, for mild erysipelas. For moderate inflammation, 1 million units are administered four times a day; in case of severe disease, the daily dose can be increased to 12 million units.

Children are administered 50-100 thousand units/kg of body weight, divided into four injections.

Benzylpenicillin salts are used:

• sodium;
• potassium;
• novocaine

At the end of treatment, Bicillin-5 is administered intramuscularly once.

In the presence of complications and frequent relapses of streptococcal infection (usually erysipelas of the lower leg, occurring 3 or more times a year), the drug is used for six months once a month.

Flaws

1. The disadvantages of natural penicillins include the frequent occurrence of cross-allergic reactions and local irritating effects (rash and itching at the injection site). When high dosages are prescribed in children, seizures may occur.
2. Natural penicillins are not prescribed simultaneously with sulfonamides and allopurinol.
3. Benzylpenicillin is not recommended for use in patients with renal and heart failure.
4. With the introduction of potassium salt, electrolyte disturbances (hyperkalemia), severe arrhythmias, and cardiac arrest may occur.
5. Sodium salt causes disturbances in myocardial contractility and provokes edema.
6. If the technique of administration (entering the vessel) of novocaine salt is not followed, ischemia and gangrene of the limb may develop.
7. To achieve a quick effect from the prescribed therapy, penicillin antibiotics for severe erysipelas of the leg are combined with aminoglycosides, macrolides and chloramphinecol.

Phenoxymethylpenicillin (Megacillin)

Available in tablet form, effective when taken orally.

It has a predominantly antibacterial and bacteriostatic effect. Used for mild erysipelas of the arm.

Side effects include dyspeptic disorders and individual intolerance to the drug.

Prescribed with caution to patients with bronchial asthma.

The effectiveness of use is enhanced when combined with nitrofuran derivatives (Furazolidone).

Amoxicillin/clavulanate (Augmentin, Amoxiclav)

Prescribed 1 g twice a day for adults.

For children up to 20-40 mg/kg, the daily dose is divided into three doses.

Elderly people are at risk of toxic liver damage. Side effects from the gastrointestinal tract (vomiting, nausea, loss of appetite, diarrhea) are observed.

Macrolides

They create a high concentration in tissues, which makes them effective in the treatment of infectious lesions of the skin. The recommended course of treatment is 7-10 days.

The drugs are usually well tolerated by patients, have low toxicity, and rarely provoke allergic reactions and dyspeptic disorders.

These antibiotics are prescribed for mild to moderate erysipelas of the skin on the legs and individual intolerance to penicillins.

Lincosamides

They have a limited spectrum of bacteriostatic activity. Effective for streptoderma.

They practically do not cause allergic reactions, but can lead to antibiotic-associated diarrhea.

Combines well with aminoglycosides and fluoroquinolones.

Adults are prescribed 300-450 mg four times a day, children up to 25 mg/kg, divided into 3-4 times.

Aminoglycosides

They have high synergism with penicillins; their combination is used for bullous inflammation of the lower leg.

Practically ineffective when taken orally. Intramuscular administration is recommended, with simultaneous administration of Megacillin or Augmentin in tablet form

Due to high toxicity, the dosage of aminoglycosides is calculated based on the patient’s weight.

For elderly people, minimal dosages are used, since they experience an age-related decrease in the filtration function of the kidneys.

• Gentamicin is administered 3-5 mg/kg once.

Treatment is carried out under the control of creatinine levels.

Cephalosporins

The third (Ceftriaxone) and fourth (Cefepime) generations are most effective.

They are well tolerated by patients, have low toxicity, and are approved for use in patients with renal failure and pregnant women. Not prescribed for concomitant diseases of the biliary tract.

Ceftriaxone and Cefepime are prescribed: adults 1 g twice a day, children 50-70 mg/kg in 2 injections parenterally.

Sulfonamides

Only Co-trimoxazole preparations (Biseptol) are used.

They are well absorbed in the gastrointestinal tract. Effective when taken orally. Used for mild erythematous inflammation of the hand.

Antibiotics of this series are highly toxic and often cause allergic reactions and dyspeptic disorders. May lead to hyperkalemia in patients with kidney and cardiovascular diseases.

Adults are prescribed 960 mg twice a day.

Children: 6-8 mg/kg in two doses.

Fluorochonolones

In the treatment of infections of the skin and soft tissues, second-generation (Ciprofloxacin) and third-generation (Levofloxacin) quinolones are used.

They are rarely prescribed due to the large number of side effects (reserve drugs for penicillin-resistant strains).

These drugs can cause drug-induced photosensitivity, tendon inflammation, and ventricular arrhythmias.

Do not use simultaneously with non-steroidal anti-inflammatory drugs (high neurotoxicity, provoke seizures).

What antibiotics can pregnant women take for erysipelas of the leg?

Penicillin preparations are most effective.

In the presence of individual intolerance, macrolides (Erytomycin, Josamycin) are prescribed. To treat severe forms of erysipelas, a combination of tableted forms of macrolides with parenteral administration of cephalosporins is used.

Additional treatments

For erysipelas of the leg, bed rest is required for the entire period of treatment.

The affected limb is placed in an elevated position to reduce swelling and pain.

In order to normalize temperature, reduce swelling and pain, non-steroidal anti-inflammatory drugs (Diclofenac, Nimesulide, Ibuprofen) are used.

NSAIDs are contraindicated in hemorrhagic erysipelas.

• To reduce itching, burning and stabilize the permeability of the vascular wall, antihistamine therapy is prescribed: Loratadine, Cetirizine, Diazolin.
• Under the control of a coagulogram, heparin, warfarin, and pentoxifylline are used to improve microcirculation and rheological properties of blood.
• In severe cases, bullous-hemorrhagic form and frequent relapses with the formation of lymphostasis (elephantiasis of the limb), glucocorticosteroids (prednisolone, dexamethasone) are prescribed.
• With the development of local complications (abscesses, phlebitis, phlegmon), as well as severe bullous form (drain, large blisters, deep erosions), surgical treatment is recommended.

The blisters are opened, necrotic areas of tissue are excised, and bandages with liquid antiseptics are applied.

During the acute period of the disease, it is prohibited to use Vishnevsky ointment, ichthyol and antibacterial ointments.

In the presence of weeping ulcers and erosions, apply antiseptic dressings with solutions of 0.02% furatsilin, 0.05% chlorhexidine, and hydrogen peroxide.

To normalize microcirculation and lymphatic drainage, physiotherapeutic procedures (suberythemal dosages of ultraviolet irradiation and laser therapy) are used.

After completing the course of antibiotic therapy, B vitamins and probiotics are prescribed to restore the intestinal microflora.

For erysipelas of the lower leg, after the acute process has resolved, it is recommended to wear elastic stockings to reduce venous and lymphatic congestion.

Classification

Local manifestations of erysipelas may be:

• erythematous (redness, burning and swelling);
• erythematous-bullous (appearance of blisters with transparent contents);
• erythematous-hemorrhagic (punctual hemorrhages stand out against the background of hyperemia);
• bullous-hemorrhagic (drain blisters with hemorrhagic contents).

The inflammatory process develops acutely and occurs with symptoms of severe intoxication, chills, fever, and enlarged regional lymph nodes.

Characteristic: sharp limitation of the focus of hyperemia in the form of “tongues of flame”, its swelling and pain.

Favorite localizations of erysipelas are:

1. Person (primary process);
2. Upper and lower extremities (relapses and repeated erysipelas);
3. Breasts, perineum and torso.

Features of streptococcal infections of skin and soft tissues

Healthy skin has natural protection against pathogenic microorganisms. This is ensured by its acidic pH level, constant exfoliation of dead cells, the bactericidal properties of polyunsaturated fatty acids and the antagonistic properties of normal microflora, which prevents the proliferation of bacteria.

Decreased immunity, hormonal imbalance, the presence of a focus of chronic infection in the body, constant damage to the skin lead to a violation of its barrier properties and the occurrence of an inflammatory process, usually associated with staphylococcal and streptococcal flora.

For streptoderma, it is necessary to immediately prescribe systemic antibiotic therapy; local treatment is not effective.

Unlike staphylococci, which affect hair follicles, streptococci act directly on the skin and have a tendency to spread quickly and involve the lymphatic system in the process. Often recurrent erysipelas leads to impaired lymphatic drainage and the development of elephantiasis.

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Skin is the outer covering of a person, which performs a specific function: protects organs and tissues from mechanical damage, provides thermoregulation, gas exchange, and prevents the penetration of pathogenic microorganisms. In some cases, the skin becomes the target of bacterial attack, which leads to the development of dermatological diseases, among which is erysipelas of the lower leg. Erysipelas is an acute infectious process caused by group A streptococci. Lack of treatment leads to progression of the disease and complications develop.

Etiology and types of erysipelas

For erysipelas to occur, three “favorable” conditions for the development of the pathological process must be present:

• Presence of a wound surface. The wound does not have to be large; a small wound or crack is enough for infection to enter;
• Penetration of a certain type of pathogen into the wound. Streptococcus A provokes inflammatory processes. In addition, the microbe promotes the production of toxic substances and disrupts the functionality of the immune system. Leads to intoxication of the body, promotes relapse of the disease;
• Decreased immune status. This moment appears to be the dominant factor for the development of an infectious process of the skin. Inflammation of the skin of the legs of an erysipelas nature practically does not occur in patients who have good immunity.

Important: the disease is often diagnosed in men and women over 45 years of age. For children under one year old, infectious pathology poses a mortal danger.

The risk group includes people with HIV infection, any cancer, diabetes mellitus, as well as the elderly. Provoking factors include concomitant diseases: varicose veins, trophic ulcers, fungal infections, obesity of any stage, alcohol addiction.

Inflammation on the leg of an erysipelas nature comes in several forms. They differ in clinical manifestations, severity, and drug treatment. Forms can sequentially move from one to another, so it is extremely important to start timely therapy.

There are the following types of disease:

1. Erythematous type. It is characterized by classic symptoms; there are no additional changes in the skin.
2. Bullous appearance. Accompanied by the formation of blisters that are filled with serous contents.
3. Hemorrhagic type. Its peculiarity is that the smallest blood vessels are damaged, resulting in the formation of blisters with hemorrhagic contents.
4. The necrotic form appears to be the most severe form of the infectious process, in which the death of the affected skin is observed.

Erysipelas affects the lower legs, feet, face, and upper limbs. It is much less often found in the groin area or other parts of the human body.

Clinical manifestations

Erysipelas of the leg is accompanied by symptoms and treatment should be done taking them into account. Local and general symptoms are distinguished. The incubation period varies from 3 to 5 days. Erysipelas on the leg, face, upper extremities and other localizations begins with an increase in body temperature, pain in the affected area

Usually on the first day the patient develops a feverish state. Body temperature rises to 38 degrees. As the pathology progresses, it increases up to 40 degrees inclusive. Symptoms of intoxication are present:

• Severe lethargy;
• Loss of appetite;
• Increased sweating;
• High sensitivity to noise and bright light.

12 hours after the appearance of the first signs, symptoms of damage to the skin and lymphatic structures are observed. They differ slightly depending on the location of the inflammatory process, but they are united by hyperemia.

Erysipelas of the lower leg can spread beyond the affected area, or remain only in a certain area. This aspect is determined by the aggressiveness of the pathogenic microorganism, immune resistance, and the time of initiation of treatment.

Clinical symptoms on the skin:

1. Severe hyperemia, which rises somewhat above the surface of the skin. From healthy tissue it is limited to a dense cushion. In severe cases it may be absent.
2. Pain when touching the affected area.
3. Swelling of the inflamed area (hands, feet, forearms, etc.).
4. When palpating the lymph nodes near the source of infection, pain is felt.
5. Against the background of the bullous form, blisters appear filled with liquid mixed with blood or serous contents.

For your information, the prevalence of erysipelas is high - it is in fourth place after acute respiratory infections, pathologies of the gastrointestinal tract and hepatitis.

Erysipelas on the leg has its own characteristics:

• The infection is always localized on the foot or lower leg, the thigh is affected in extremely rare cases;
• Often, painful oval-shaped swellings form in the area of ​​the inguinal folds - the inguinal lymph nodes become inflamed, which restrain the pressure of the infection;
• With intense lymphostasis, swelling spreads to the foot, lower leg and thighs. It is easy to detect if you press on the skin with your finger, then after removing the finger, the notch remains for 5-15 seconds.

In most clinical pictures, erysipelas of the lower extremities occurs much more easily than with other localizations of the infectious process. The exceptions include the necrotic and complicated form.

Drug therapy for erysipelas

How to treat erysipelas of the leg? The treatment regimen is based on the form of the pathology, clinical manifestations, severity of the inflammatory process and other factors. If the disease is mild, then drug therapy is required; surgery is not treated.

Treatment of erysipelas of the leg can be carried out at home in accordance with the recommendations of a medical specialist. If the patient does not feel well or has severe inflammation, he may be hospitalized.

It is worth knowing: if the affected area is the face, then therapy is always carried out only in a hospital setting.

For erysipelas of the legs, antibiotics are used:

1. Amoxiclav - belongs to the penicillin series. Prescribed with caution for pathologies of the gastrointestinal tract, liver failure, and impaired liver function.
2. Sulfalene, Sulfanilamide - belong to sulfonamides. It should not be prescribed for anemia, pathologies of the hematopoietic system, for patients with renal and liver failure, or for porphyria.

The duration of antibiotic treatment is determined individually. Typically, the duration of the therapeutic course varies from 10 to 15 days.

The treatment regimen must include antihistamines. Since a pathological organism can lead to the development of a severe allergic reaction. Most often, the doctor recommends the use of drugs - Loratadine, Desloratadine. If the patient does not have the opportunity to buy these medications, then an alternative is offered - Suprastin, Diphenhydramine, etc.

To treat erysipelas, non-hormonal anti-inflammatory drugs are used. Nimesulide is recommended, since the drug is characterized by a minimal number of side effects. Alternatively, Ketorolac, Diclofenac, Ibuprofen.

What ointments to use for erysipelas, do patients ask? Ointment for erysipelas is never prescribed at the initial stage of the disease. At the early stage of the disease, doctors focus exclusively on antibacterial and symptomatic therapy. The use of ointments for erysipelas on the legs is acceptable for the blistering form of the disease:

• Ichthyol ointment has a pronounced antiseptic effect, provides a high degree of disinfection, and reduces the severity of the inflammatory process;
• Vishnevsky ointment is necessary for severe forms of the disease; it effectively fights old infections.

What ointments are used at home? To speed up the healing process, use the topical drug Naftalan. The drug relieves redness, swelling, and accelerates the restoration of the skin.

The doctor will tell you how to treat erysipelas if complications arise. The patient must be hospitalized in a medical facility, treatment is carried out under medical supervision.

Surgical intervention

Sometimes to the question of how to get rid of erysipelas, there is only one answer - surgery. Indications for surgical manipulation include the formation of ulcers, abscesses, phlegmon, tissue necrosis or a bullous form of erysipelas.

Note: surgery is performed under general anesthesia and takes no more than 40 minutes.

During a medical procedure, the doctor opens the erysipelas of the lower leg and gets rid of the purulent contents. The wound surface is not sutured, left open, and a rubber tube is installed to allow fluid to drain out. If dead tissue is found, it is removed, then drug treatment continues.

In general, pathology therapy takes 2-3 weeks. As the number of pathogens decreases, the skin begins to renew itself. Hyperemia decreases, a film remains in place of the damaged area - “old” skin. In case of final rejection, it is removed independently; underneath there is an unchanged epithelial layer. The prognosis is positive if complications are prevented.

Erysipelas or erysipelas– a common infectious-allergic disease of the skin and subcutaneous tissue, prone to relapse. It is caused by group A beta-hemolytic streptococcus. The name of the disease comes from the French word

and means "red". This term indicates the external manifestation of the disease: a red, swollen area forms on the body, separated from healthy skin by a raised ridge.

Statistics and facts

Erysipelas ranks 4th among infectious diseases, second only to respiratory and intestinal diseases, as well as

hepatitis

The incidence is 12-20 cases per 10,000 population. The number of patients increases in summer and autumn.

The number of relapses over the past 20 years has increased by 25%. 10% of people experience a repeat episode of erysipelas within 6 months, 30% within 3 years. Repeated erysipelas in 10% of cases ends with lymphostasis and elephantiasis.

Doctors note an alarming trend. If in the 70s the number of severe forms of erysipelas did not exceed 30%, today such cases are more than 80%. At the same time, the number of mild forms has decreased, and the period of fever now lasts longer.

30% of cases of erysipelas are associated with impaired blood and lymph flow in the lower extremities, with varicose veins, thrombophlebitis and lymphovenous insufficiency.

The mortality rate from complications caused by erysipelas (sepsis, gangrene, pneumonia) reaches 5%.

Who is more likely to suffer from erysipelas?

• The disease affects people of all age groups. But the majority of patients (over 60%) are women over 50 years old.
• Erysipelas also occurs in infants when streptococcus gets into the umbilical wound.
• There is evidence that people with the third blood group are most susceptible to erysipelas.
• Erysipelas is a disease of civilized countries. On the African continent and in South Asia, people get sick extremely rarely.

Erysipelas occurs only in people with reduced immunity, weakened by stress or chronic diseases. Studies have shown that the development of the disease is associated with an inadequate response of the immune system to streptococcus entering the body. The balance of immune cells is disrupted: the number of T-lymphocytes and immunoglobulins A, M, G decreases, but at the same time an excess of immunoglobulin E is produced. Against this background, the patient develops an allergy.

With a favorable course of the disease and proper treatment, the symptoms subside on the fifth day. Full recovery occurs in 10-14 days.

It is interesting that, although erysipelas is an infectious disease, it is successfully treated by traditional healers. Qualified doctors recognize this fact, but with the caveat that only uncomplicated erysipelas can be treated with traditional methods. Traditional medicine explains this phenomenon by the fact that conspiracies are a kind of psychotherapy that relieves stress - one of the predisposing factors in the development of erysipelas.

The structure of the skin and the functioning of the immune system

Leather– a complex multi-layered organ that protects the body from environmental factors: microorganisms, temperature fluctuations, chemicals, radiation. In addition, the skin performs other functions: gas exchange, respiration, thermoregulation, excretion

toxins

Skin structure:

1. Epidermis – superficial layer of skin. The stratum corneum of the epidermis is keratinized cells of the epidermis, covered with a thin layer of sebum. This is reliable protection against pathogenic bacteria and chemicals. Under the stratum corneum there are 4 more layers of the epidermis: shiny, granular, spinous and basal. They are responsible for skin renewal and healing of minor injuries.
2. The actual skin or dermis- the layer that is located under the epidermis. It is he who suffers most from erysipelas. The dermis contains:
   • blood and lymphatic capillaries,
   • sweat and sebaceous glands,
   • hair bags with hair follicles;
   • connective and smooth muscle fibers.
3. Subcutaneous fat. Lies deeper than the dermis. It consists of loosely arranged connective tissue fibers and accumulations of fat cells between them.

The surface of the skin is not sterile. It is populated by bacteria friendly to humans. These microorganisms prevent pathogenic bacteria that get on the skin from multiplying and they die without causing disease.

The immune system includes:

1. Organs: bone marrow, thymus, tonsils, spleen, Peyer's patches in the intestines, lymph nodes and lymphatic vessels,
2. Immune cells: lymphocytes, leukocytes, phagocytes, mast cells, eosinophils, natural killer cells. It is believed that the total mass of these cells reaches 10% of body weight.
3. Protein molecules– antibodies must detect, recognize and destroy the enemy. They differ in structure and function: igG, igA, igM, igD, IgE.
4. Chemical substances: lysozyme, hydrochloric acid, fatty acids, eicosanoids, cytokines.

Let's look at how the immune system works when streptococcus enters the body:

1. Lymphocytes, or rather their receptors - immunoglobulins, recognize the bacterium.
2. React to the presence of bacteria T-helpers. They actively divide and release cytokines.
3. Cytokines activate the work of leukocytes, namely phagocytes and T-killers, designed to kill bacteria.
4. B cells produce antibodies specific to a given organism that neutralize foreign particles (areas of destroyed bacteria, their toxins). After this, they are absorbed by phagocytes.
5. After defeating the disease, special T lymphocytes remember the enemy by his DNA. When it enters the body again, the immune system is activated quickly, before the disease has time to develop.

Causes of erysipelas Streptococcus Streptococci- a genus of spherical bacteria that are very widespread in nature due to their vitality. However, they do not tolerate heat very well. For example, these bacteria do not reproduce at a temperature of 45 degrees. This is associated with low incidence rates of erysipelas in tropical countries.

Erysipelas is caused by one of the types of bacteria - group A beta-hemolytic streptococcus. This is the most dangerous of the entire family of streptococci.

If streptococcus enters the body of a person with a weakened immune system, then erysipelas, tonsillitis, scarlet fever, rheumatism, myocarditis, glomerulonephritis occur.

If streptococcus enters the body of a person with a sufficiently strong immune system, then he can become a carrier. Streptococcus carriage was detected in 15% of the population. Streptococcus is part of the microflora and lives on the skin and mucous membranes of the nasopharynx without causing disease.

Source of infection with erysipelas can become carriers and patients of any form of streptococcal infection. The causative agent of the disease is transmitted through contact, household items, dirty hands and airborne droplets.

Streptococci are dangerous because they secrete toxins and enzymes: streptolysin O, hyaluronidase, nadase, pyrogenic exotoxins.

How streptococci and their toxins affect the body:

• Destroy (dissolve) the cells of the human body;
• Stimulate T-lymphocytes and endothelial cells to produce excess amounts of cytokines - substances that trigger the body's inflammatory response. Its manifestations: severe fever and blood flow to the affected area, pain;
• Reduce the level of anti-streptococcal antibodies in the blood serum, which prevents the immune system from fighting the disease;
• They destroy hylauric acid, which is the basis of connective tissue. This property helps the pathogen spread in the body;
• Leukocytes influence immune cells, disrupting their ability to phagocytose (capture and digest) bacteria;
• Suppresses the production of antibodies needed to fight bacteria
• Immune damage to blood vessels. Toxins cause an inadequate immune response. Immune cells mistake the walls of blood vessels for bacteria and attack them. Other tissues of the body also suffer from immune aggression: joints, heart valves.
• Causes vasodilation and increased permeability. The walls of the vessels allow a lot of fluid to pass through, which leads to swelling of the tissue.

Streptococci are extremely variable, so lymphocytes and antibodies cannot “remember” them and provide immunity. This feature of bacteria causes frequent relapses of streptococcal infections.

Leather properties

1. Skin damage:
   • animal and insect bites;
   • cuts and abrasions;
   • ulcers and bedsores;
   • umbilical wound in newborns;
   • venous catheters and injection drug sites.

   Any damage to the skin can become an entry point for streptococcus. Bacteria penetrate into the deep layers of the skin and multiply in the lymphatic capillaries. They release a toxin into the blood that poisons the body. All manifestations of erysipelas are the body’s reaction to the presence of bacteria and their toxins.
   

2. Occupational hazards:
   • contact with skin of chemical compounds;
   • frequent pollution;
   • wearing rubber clothing and shoes.

   The professions of miners, drivers, mechanics, agricultural workers, metallurgical and chemical industry workers are associated with such factors.
   

3. Viral skin lesions:
   • herpes;
   • shingles;
   • chicken pox.

   These infections weaken the immune system and cause skin rashes in the form of fluid-filled blisters. Once opened, bacteria easily penetrate the skin;
   

4. Chronic dermatosis and other skin lesions:
   • eczema,
   • atopic dermatitis,
   • psoriasis,
   • neurodermatitis;
   • hives;
   • contact dermatitis.

   These diseases are allergic in nature. Immune cells attack the epidermis, reducing local immunity and causing swelling. If bacteria penetrate into scratches and scratches, they quickly multiply in allergenic skin;
   

5. Purulent skin lesions:
   • furuncle;
   • carbuncle;
   • folliculitis.

   If the inflammation of the sebaceous glands is caused by streptococcus, the bacteria, independently or after squeezing out the abscess, penetrate into the surrounding tissue and lymphatic vessels. There they begin to multiply and secrete toxins;
   

6. Poor blood circulation and lymph flow:
   • thrombophlebitis;
   • phlebeurysm;
   • lymphovenous insufficiency.

   Impaired blood supply due to damage to blood and lymphatic vessels leads to oxygen starvation and nutrient deficiency in the surrounding area. This weakens the immune system and makes the skin susceptible to infections. In addition, stagnation of lymph in the vessels promotes the proliferation of streptococcus;
   

7. Scarring:
   • post-traumatic;
   • postoperative.

   Keloid scar tissue consists of undifferentiated epidermal cells, which the body perceives as foreign and attacks them. In addition, scar tissue has impaired blood circulation, so it becomes a good breeding ground for streptococcus;
   

8. Fungal diseases feet, scalp. Fungal diseases disrupt the integrity of the skin, and it is not able to perform its protective function. Bacteria easily penetrate into cracks in the interdigital folds, causing erysipelas of the lower leg;
9. Complications diseases of the ENT organs and eyes:
   • rhinitis;
   • otitis;
   • conjunctivitis.

   There is a danger of streptococcus spreading through the bloodstream into the lymphatic capillaries of the skin. In this case, most often erysipelas occurs on the face and scalp, but it can also appear on other parts of the body, especially where blood circulation is impaired;
   

Clothing that injures the skin and impairs blood circulation. Tight underwear and tight jeans interfere with the movement of blood through the vessels. Small abrasions that occur when the seam rubs against the skin allow bacteria to penetrate into it. If clothes are made of synthetic materials, then they do not absorb moisture and a greenhouse effect is created. Such conditions are favorable for the proliferation of streptococci.

Immune status Streptococcus is very common in the environment, and every person encounters it on a daily basis. In 15-20% of the population, it constantly lives in the tonsils, sinuses, and cavities of carious teeth. But if the immune system is able to restrain the proliferation of bacteria, then the disease does not develop. When something undermines the body's defenses, bacteria multiply and a streptococcal infection begins.

Factors that inhibit the body's immune defense:

1. Taking medications that suppress the immune system:
   • steroid hormones;
   • cytostatics;
   • chemotherapy drugs.
2. Metabolic diseases:
   • diabetes;
   • renal failure;
   • cirrhosis of the liver;
   • hypothyroidism
3. Diseases associated with changes in blood composition:
   • atherosclerosis;
   • anemia;
   • elevated cholesterol levels.
4. Immune system diseases
   • AIDS;
   • hypercytokinemia;
   • severe combined immunodeficiency.
5. Malignant neoplasms
6. Chronic diseases of the ENT organs:
   • sinusitis;
   • sinusitis;
   • tonsillitis;
   • otitis.
7. Exhaustion as a result
   • lack of sleep;
   • malnutrition;
   • stress;
   • vitamin deficiency.
8. Bad habits
   • alcoholism;
   • addiction;
   • smoking.
9. Hypothermia.

To summarize: in order for erysipelas to develop, the following factors are necessary:

• the entry point for infection is skin damage;
• impaired blood and lymph circulation;
• decreased general immunity;
• hypersensitivity to streptococcal antigens (toxins and cell wall particles).

In which areas does erysipelas most often develop?

1. Leg. Erysipelas on the legs can be the result of fungal infections of the feet, calluses, or injuries. Streptococci penetrate through skin lesions and multiply in the lymphatic vessels of the leg. The development of erysipelas is promoted by diseases that cause circulatory disorders: obliterating atherosclerosis, thrombophlebitis, varicose veins.
2. Hand. Erysipelas occurs in men 20-35 years of age due to intravenous drug administration. Streptococci penetrate skin lesions at the injection site. In women, the disease is associated with removal of the mammary gland and stagnation of lymph in the arm.
3. Face. With streptococcal conjunctivitis, erysipelas develops around the eye socket. With otitis media, the skin of the auricle, scalp and neck becomes inflamed. Butterfly lesions of the nose and cheeks are associated with streptococcal sinus infections or boils. Erysipelas on the face is always accompanied by severe pain and swelling.
4. Torso. Erysipelas occurs around surgical sutures when patients do not comply with asepsis or due to the fault of medical personnel. In newborns, streptococcus can penetrate the umbilical wound. In this case, erysipelas is very difficult.
5. Crotch. The area around the anus, scrotum (in men) and labia majora (in women). Erysipelas occurs at the site of abrasions, diaper rash, and scratching. Particularly severe forms with damage to the internal genital organs occur in women giving birth.

Symptoms of erysipelas, photos. Erysipelas begins acutely. As a rule, a person can even indicate the time when the first symptoms of the disease appeared.

Deterioration in general health 1. severe chills that literally shake the body;

2. temperature rise to 38-40 degrees, fever lasts 5-10 days;
3. convulsions, delirium and clouding of consciousness are possible;
4. severe weakness, dizziness;
5. nausea, sometimes vomiting;
6. muscle and joint pain.

Symptoms of general intoxication are the result of the release of the first wave of toxins released by bacteria into the blood. These substances poison the body, especially affecting nerve cells and meninges.

• Skin redness. Changes in the skin appear 10-20 hours after the onset of the disease. The affected area has a uniform, bright red color. The development of redness is associated with local dilation of blood capillaries, which occurs as a result of the action of staphylococcal toxin. Redness disappears after 7-14 days. In its place, peeling occurs. This is the rejection of epidermal cells damaged by bacteria.
• Roller. Inflammation is limited to a ridge that rises above healthy skin. In this place, streptococci are most active, so the signs of inflammation are most pronounced here: swelling, pain, fever.
• The source of inflammation quickly increases in size. Streptococci multiply and invade new areas of the skin.
• Uneven edges of inflammation. They look like flames or a geographical map. This is evidence of how staphylococci penetrate healthy skin.
• Pain, burning, a feeling of fullness and tension, especially in the periphery. The pain intensifies when palpated. Painful sensations are the result of irritation of the nerve endings in the skin by toxins and compression of them as a result of swelling of the skin.
• Swelling of the skin. Bacterial toxins make the walls of blood vessels easily permeable. The liquid component of blood (plasma) leaks through them. It permeates the affected area of ​​the skin, accumulating between the cells. Due to the accumulation of fluid, the skin becomes shiny, but its surface is not damaged.
• Enlarged regional lymph nodes. Often the nodes are painful and adherent to the skin, which indicates their inflammation. Staphylococci multiply in lymphatic capillaries and spread throughout the lymphatic system. Lymph nodes filter lymph, trap bacteria, and work hard to suppress infection.

Complicated forms of erysipelas. Against the background of reddened, swollen skin, the following may appear:

• Hemorrhages– this is a consequence of damage to blood vessels and the release of blood into the intercellular space (erythematous-hemorrhagic form);
• Bubbles filled with transparent contents. The first days they are small, but they can increase and merge with each other (erythematous-bullous form).
• Blisters filled with bloody or purulent contents, surrounded by hemorrhages (bullous-hemorrhagic form).

Such forms are more severe and more often cause relapses of the disease. Repeated manifestations of erysipelas may appear in the same place or in other areas of the skin.

Diagnosis of erysipelas Which doctor should you contact if symptoms of erysipelas appear? When the first signs of disease appear on the skin, contact a dermatologist. He will make a diagnosis and, if necessary, refer you to other specialists involved in the treatment of erysipelas: an infectious disease specialist, a therapist, a surgeon, an immunologist.

At the doctor's appointment

Survey In order to correctly diagnose and prescribe effective treatment, a specialist must distinguish erysipelas from other diseases with similar symptoms: abscess, phlegmon, thrombophlebitis.

The doctor will ask the following questions. The doctor will ask the following questions:

• How long ago did the first symptoms appear?
• Was the onset of the disease acute or did the symptoms develop gradually? When did the skin manifestations appear, before or after the temperature rise?
• How quickly does inflammation spread?
• What sensations occur at the site of the lesion?
• How severe is the intoxication, is there general weakness, headache, chills, nausea?
• Is your temperature elevated?

Inspection of the lesion in erysipelas. During examination, the doctor reveals characteristic signs of erysipelas:

• the skin is hot, dense, smooth;
• redness is uniform, with possible hemorrhages and blisters;
• uneven edges are clearly defined and have a marginal ridge;
• the surface of the skin is clean, not covered with nodules, crusts and skin flakes;
• pain upon palpation, absence of severe pain at rest;
• pain is mainly along the edge of the inflammation, in the center the skin is less painful;
• nearby lymph nodes are enlarged, adherent to the skin and painful. From the lymph nodes to the inflamed area, a pale pink path stretches along the movement of the lymph - an inflamed lymphatic vessel;

General blood test for erysipelas:

• the total and relative number of T-lymphocytes is reduced, which indicates suppression of the immune system by streptococci;
• increased ESR (erythrocyte sedimentation rate) – evidence of an inflammatory process;
• the number of neutrophils is increased, which indicates an allergic reaction.

When is a bacteriological examination prescribed for erysipelas? In case of erysipelas, a bacteriological examination is prescribed to determine which pathogen caused the disease and which antibiotics it is most sensitive to. This information should help your doctor choose the most effective treatment.

However, in practice such research is not very informative. Only in 25% of cases is it possible to identify the pathogen. Doctors attribute this to the fact that antibiotic treatment quickly stops the growth of streptococcus. A number of scientists believe that bacteriological examination for erysipelas is inappropriate.

Material for bacteriological examination is taken from tissue if difficulties arise in establishing a diagnosis. Examine the contents of wounds and ulcers. To do this, a clean glass slide is applied to the lesion and an imprint containing bacteria is obtained, which is examined under a microscope. To study the properties of bacteria and their sensitivity to antibiotics, the resulting material is grown on special nutrient media.

Treatment of erysipelas

Erysipelas requires complex therapy. Local treatment is not enough; it is necessary to take antibiotics, drugs to combat allergies and measures to strengthen the immune system.

How to boost immunity?

When treating erysipelas, it is very important to improve immunity. If this is not done, the disease will return again and again. And each subsequent case of erysipelas is more severe, is more difficult to treat and more often causes complications, which can lead to disability.

1. Identify foci of chronic infection which weaken the body. To fight the infection, you must undergo a course of antibiotic therapy.
2. Restore normal microflora– consume fermented milk products daily. Moreover, the shorter their shelf life, the more they contain live lactobacilli, which will prevent streptococci from multiplying.
3. Alkaline mineral waters help remove poisons from the body and eliminate symptoms of intoxication. You need to drink them in small portions, 2-3 sips throughout the day. During fever, you must drink at least 3 liters of fluid.
4. Easily digestible proteins: lean meat, cheese, fish and seafood. They are recommended to be consumed boiled or stewed. Proteins are needed by the body to create antibodies to fight streptococci.
5. Fats help the skin recover faster. Healthy fats are found in vegetable oils, fish, nuts and seeds.
6. Vegetables, fruits and berries: especially carrots, pears, apples, raspberries, cranberries, currants. These products contain potassium, magnesium, phosphorus, iron and a complex of vitamins necessary to strengthen the immune system.
7. Fighting anemia. A decrease in hemoglobin in the blood has a bad effect on the immune system. In this situation, iron supplements, hematogen, apples, and persimmons will help.
8. Strengthening the immune system. For one month, 2 times a year, it is recommended to take natural preparations to stimulate the immune system: echinacea, ginseng, Rhodiola rosea, Eleutherococcus, pantocrine. Other mild immunomodulators are also effective: immunofan, licopid.
9. Fresh honey and bee bread– these bee products are rich in enzymes and chemical elements necessary for promoting health.
10. UV irradiation problem areas 2 times a year. Sunbathing must be done in doses, starting from 15 minutes a day. Increase your time in the sun by 5-10 minutes every day. Sunburn can cause recurrence of erysipelas. You can undergo Ural Federal Physics in the physical room of any clinic. In this case, the radiation dose is determined by the doctor.
. Get outdoors every day. Walking for 40-60 minutes a day 6 times a week provides normal physical activity. It is advisable to do gymnastics 2-3 times a week. Yoga helps a lot. It helps improve immunity, stress resistance and improve blood circulation.
11. Healthy sleep helps restore strength. Set aside at least 8 hours a day for rest.
12. Don't let overwork, hypothermia, overheating, prolonged nervous tension. Such situations reduce the body's protective properties.
13. Not recommended:
    • alcohol and cigarettes;
    • products containing caffeine: coffee, cola, chocolate;
    • spicy and salty foods.

Treatment of erysipelas Erysipelas is an infectious disease, so the basis of its treatment is antibiotic therapy. Antibiotics, together with antibacterial drugs from other groups, destroy the pathogen. Antihistamines help treat allergies to streptococcal toxins.
Antibiotics

For a speedy recovery and prevention of relapses, comprehensive treatment is necessary. In addition to antibiotics, other groups of drugs are also prescribed.

1. Desensitizing (anti-allergic) drugs: tavegil, suprastin, diazolin. Take 1 tablet 2 times a day for 7-10 days. Reduce swelling and allergic reaction at the site of inflammation, promote rapid resorption of the infiltrate.
2. Sulfonamides: biseptol, streptocide 1 tablet 4-5 times a day. The drugs interfere with the formation of growth factors in bacterial cells.
3. Nitrofurans: furazolidone, furadonin. Take 2 tablets 4 times a day. They slow down the growth and reproduction of bacteria, and in high dosages cause their death.
4. Glucocorticoids for developing lymphostasis: prednisolone, the dose of which is 30-40 mg (4-6 tablets) per day. Steroid hormones have a strong anti-allergic effect, but at the same time significantly suppress the immune system. Therefore, they can only be used as prescribed by a doctor.
5. Biostimulants: methyluracil, pentoxyl. Take 1-2 tablets 3-4 times a day in courses of 15-20 days. Stimulates the formation of immune cells, accelerates restoration (regeneration) of the skin in the damaged area.
6. Multivitamin preparations: ascorutin, ascorbic acid, panhexavit. Vitamin preparations strengthen the walls of blood vessels damaged by bacteria and increase the activity of immune cells.
7. Thymus preparations: thymalin, tactivin. The drug is administered intramuscularly at a dose of 5-20 mg, 5-10 injections per course. They are necessary to improve immune function and increase the number of T-lymphocytes.
8. Proteolytic enzymes: lidase, trypsin. Subcutaneous injections are given daily to improve tissue nutrition and resorption of infiltrate.

Without proper treatment and specialist supervision, erysipelas can cause serious complications and death. Therefore, do not self-medicate, but urgently seek help from a qualified specialist.

Treatment of the skin around the lesion

1. Applications with 50% dimexide solution. A 6-layer gauze pad is moistened with the solution and applied to the affected area so that it covers 2 cm of healthy skin. The procedure is carried out 2 times a day for 2 hours. Dimexide anesthetizes, relieves inflammation, improves blood circulation, has an antimicrobial effect and increases the effect of antibiotic treatment.
2. Enteroseptol in the form of powders. Clean, dry skin is sprinkled with powder from crushed enteroseptol tablets twice a day. This drug causes the death of bacteria in the affected area and prevents the addition of other microorganisms.
3. Dressings with furatsilin solutions or microcide. A bandage of 6-8 layers of gauze is generously moistened with the solution, covered with compress paper on top and left on the affected skin for 3 hours in the morning and evening. Solutions of these drugs have antimicrobial properties and destroy bacteria in the thickness of the skin.
4. Oxycyclosol aerosol. This remedy treats areas of erysipelas with an area of ​​up to 20 sq.cm. The drug is sprayed, holding the balloon at a distance of 20 cm from the skin surface. You can repeat this procedure 2 times a day. This product creates a protective film on the skin that has an antibacterial, anti-inflammatory and anti-allergic effect.
5. It is prohibited to use synthomycin or ichthyol ointment or Vishnevsky's liniment to treat erysipelas. An ointment dressing increases inflammation and can cause an abscess.

It is not recommended to use traditional medicine recipes on your own. They are often presented in a distorted or incomplete form. The components of these products can additionally irritate the skin. And the components that warm up and accelerate the movement of blood contribute to the spread of bacteria throughout the body.
Local hygiene for erysipelas

The patient is not dangerous to others and can be treated at home. But remember, during the period of illness you must especially carefully observe the rules of personal hygiene. This promotes a speedy recovery.

1. Change your underwear and bed linen daily. It must be washed at a temperature of at least 90 degrees and ironed with a hot iron.
2. Clothing should provide air access to the affected area, preferably leaving it open. Wear clothes made from natural fabrics that prevent sweating.
3. It is recommended to shower daily. The area of ​​erysipelas is carefully washed with soapy water, without using a sponge or washcloth. Failure to comply with this rule may cause the addition of another infection, since the affected area is very susceptible to bacteria and fungi.
4. The water should be warm; hot baths are strictly prohibited and can cause infection to spread throughout the body.
5. After washing, do not dry the skin, but dry it gently. For this, it is better to use disposable paper towels.
6. Wash the inflamed area 3 times a day with a decoction of chamomile and coltsfoot. Herbs are mixed in a 1:1 ratio. One tablespoon of the mixture is poured into a glass of hot water, heated in a water bath for 10 minutes, and allowed to cool.
7. At the healing stage, when peeling has appeared, the skin is lubricated with Kalanchoe juice or rosehip oil.
8. Erysipelas on the face or genitals can be washed with a decoction of string or calendula 2-3 times a day. These herbs have bactericidal properties and reduce allergies.

Physiotherapeutic procedures for the treatment of erysipelas

1. Ural Federal District on the affected area with erythemal doses (until redness appears on healthy skin). Prescribed from the first days in parallel with taking antibiotics. The course of treatment is 2-12 sessions.
2. High frequency magnetic therapy to the area of ​​the adrenal glands. Radiation stimulates the adrenal glands to release more steroid hormones. These substances inhibit the production of inflammatory mediators. As a result, swelling, pain, and the attack of immune cells on the skin are reduced. It is also possible to reduce the allergic reaction to substances produced by bacteria. However, this method suppresses the immune system, so it is prescribed at the beginning of treatment (no more than 5-7 procedures), only if autoantibodies are detected in the blood.
3. Electrophoresis with potassium iodide or lidase, ronidase. Provides lymph outflow and reduces infiltration. Prescribed 5-7 days after the start of treatment. The course consists of 7-10 procedures.
4. UHF. Warms tissues, improves their blood supply and relieves inflammation. Treatment is prescribed on days 5-7 of illness. 5-10 sessions are required.
5. Infrared laser therapy. Activates protective processes in cells, improves tissue nutrition, accelerates local blood circulation, eliminates swelling and increases the activity of immune cells. Prescribed during the recovery phase. Promotes healing of ulcers in complicated erysipelas.
6. Applications with warm paraffin applied 5-7 days after the onset of the disease. They improve tissue nutrition and contribute to the disappearance of residual effects. To prevent relapses, repeated courses of physical procedures are recommended after 3, 6 and 12 months.

As you can see, different stages of the disease require different physiotherapeutic procedures. Therefore, such treatment should be prescribed by a qualified physiotherapist.
Prevention of erysipelas

1. Treat foci of chronic inflammation in a timely manner. They weaken the immune system and from them bacteria can spread throughout the circulatory system and cause erysipelas.
2. Maintain personal hygiene. Shower at least once a day. A contrast shower is recommended. Alternate warm and cool water 3-5 times. Gradually increase the temperature difference.
3. Use soap or shower gel with a pH less than 7. It is desirable that it contains lactic acid. This helps create a protective layer on the skin with an acidic reaction that is harmful to fungi and pathogenic bacteria. Washing too often and using alkaline soaps deprives the body of this protection.
4. Avoid diaper rash. Use baby powder in skin folds where the skin is constantly damp.
5. Massage If possible, take massage courses 2 times a year. This is especially true for people with impaired blood circulation and lymph movement.
6. Treat skin lesions with antiseptics: hydrogen peroxide, ioddicirin. These products do not stain the skin and can be used on open areas of the body.
7. Treat fungal infections of the feet promptly. They most often become entry points for infections.
8. Sunburn, diaper rash, chapping and frostbite reduce local skin immunity. To treat them, use Panthenol spray or Pantestin, Bepanten ointments.
9. Trophic ulcers and scars You can lubricate it with camphor oil 2 times a day.
10. Wear loose clothing. It should absorb moisture well, allow air to pass through and not rub the skin.

Erysipelas is a common problem that can affect anyone. Modern medicine with the help of antibiotics is able to overcome this disease in 7-10 days. And it is in your power to make sure that erysipelas does not reoccur.

Erysipelas is a highly contagious disease that affects the skin and mucous membranes and is caused by streptococcus. The disease leads to serious complications from the cardiovascular and renal systems. Treatment with antibiotics for erysipelas of the leg should be long-term (at least 10 days) and timely.

Antibiotics are the most effective method of treating microbial inflammation. Antibacterial drugs are available in tablets, injections, capsules, and suppositories.

Erysipelas is the fourth most common infectious disease. Caused by streptococcus, almost all groups of antibacterial drugs act on it. Protected penicillins, macrolides, cephalosporins will quickly cope with this problem. Self-treatment and uncontrolled use of medications leads to resistance. Antibiotics for erysipelas on the leg are prescribed only by a doctor who selects an adequate dosage.

Groups of drugs for erysipelas

The genetic material of microbes and their properties are constantly changing and adapting to the internal environment of the human body. Beta-lactam antibiotics cannot fight new bacterial strains. Substances from streptococcus destroy the medicinal enzyme beta-lactam, this group of drugs is being replaced by new medications. Preference is given to protected penicillins (Amoxiclav), cephalosporins (Ceftriaxone), macrolides (Erythromycin). Antibiotics of the penicillin and cephalosporin series contain a beta-lactam component that is protected from streptococcal aggression.

Erysipelas affects people with weakened immune systems, after a cold, or hypothermia. The inflamed lesion appears on the upper and lower extremities (usually on the legs), head, and face. Depending on the location, the severity of the disease and its consequences are determined. A secondary infection often occurs. It requires proper treatment. To kill several pathological processes, doctors use broad-spectrum antibiotics.

Penicillin series

Treatment of all bacterial infections begins with the administration of penicillin. The drugs come into contact with the bacterial membrane, block the synthesis of special proteins, and destroy microorganisms. There are specially developed compounds (clavulanic acid, sulbactam, tazobactam) that act on new strains of bacteria. Popular penicillin antibiotics:

1. Benzylpenicillin has been used for a long time to treat erysipelas. The antibiotic is administered intramuscularly, subcutaneously. It quickly spreads throughout the body through the blood. The daily dose depends on the severity of the disease (from 250,000 to 60 million units). The disadvantages of Benzylpenicillin are the high frequency of administration (4 - 6 times a day), there are no tablet forms, and frequent allergic reactions. If the therapy is followed, the patient will be cured in 10 days.
2. Amoxicillin is a broad-spectrum antibiotic. Efficiency increases when used simultaneously with clavulanic acid. Amoxicillin tablets are available in 250 and 500 mg doses. Apply twice daily.
3. Amoxiclav consists of amoxicillin and clavulanic acid. The combination allows you to act on a huge number of pathogens, on changing strains. The drug is also prescribed to newborns. For erysipelas it is used in the form of tablets 1000, 625 mg and powder for oral suspension. Drink twice a day for 7-14 days. Amoxiclav is well tolerated and there are fewer unwanted effects.
4. Ampicillin is a semi-synthetic penicillin. It is not destroyed by hydrochloric acid of the stomach when taken orally, and is found in high concentrations after intravenous administration. The tablets are taken twice a day, regardless of meals. In severe cases, it is administered intravenously 2-3 times a day.

After administration of the antibiotic, body temperature decreases, inflammation in the leg decreases, and the patient’s well-being improves.

Macrolide groups

Treatment for erysipelas on the leg should be safe and effective. Macrolides are antibiotics that combine these characteristics. They affect gram-positive and gram-negative bacteria, have immunomodulatory, anti-inflammatory effects, and rarely cause adverse reactions. Macrolides are recommended to be used after penicillins and cephalosporins in order to reduce antibiotic resistance. Treatment requires a clear regimen; you should not skip it or double the dose yourself. Effective medications for erysipelas include:

• Erythromycin is a drug similar to penicillins. It is often used for allergies and intolerance to penicillin antibiotics. It prevents the proliferation of microorganisms, and patients recover quickly. Available in tablets, capsules, ointments. During treatment with Erythromycin, it is prohibited to drink alcohol. The tablets should be taken one hour before meals with 1 glass of water. It is recommended to use 4 times a day. Dispensed at the pharmacy with a prescription;
• Clarithromycin is an antimicrobial agent. The advantage over erythromycin is to take only twice a day, regardless of meals;
• Azithromycin fights infections of the skin and soft tissues. The course dose is 1.5 g. Take 500 mg once a day for three days.

Local medications

Streptococcus enters the body and actively multiplies, causing unpleasant symptoms. Systemic antibiotics help kill the microbe and prevent its complications. Local therapy eliminates swelling, pain, and redness on the skin of the leg. Erythromycin, syntomycin, tetracycline ointments are the main opponents of erysipelas.

1. Erythromycin ointment prevents the proliferation of microbes in the wound. It penetrates deep into the tissue, the placenta. Pregnant women should not use it. Medicines are applied 2-3 times a day in a thin layer. Contraindicated for internal use, external use only. If there is a burning sensation, severe itching, extensive redness, an allergic reaction develops. It is impossible to increase the dose or frequency to avoid side effects.
2. Tetracycline ointment has a number of advantages over erythromycin: it does not penetrate deep into the skin, does not enter the blood or placenta, and can be used by pregnant women. The drug is applied to the skin 1-2 times a day in a small layer, and an aseptic bandage is applied on top. Possible allergic manifestations.
3. Syntomycin is an antibacterial drug based on chloramphenicol. Apply to the wound 2-3 times a day. The drug reduces the effect of penicillins and cephalosporins. Synthomycin ointment often causes allergies.

Erysipelas can be cured with antibiotics. But the patient suffers from unbearable itching, burning, and fever. Symptomatic treatment is required.

1. Bed rest.
2. Drink plenty of water 1.5-2 liters per day to relieve intoxication syndrome.
3. Nonsteroidal anti-inflammatory drugs (Diclofenac, Nimesulide) relieve pain, swelling, and normalize body temperature.
4. Antihistamines (Tavegil, Loratadine, Suprastin) are used to relieve itching.
5. It is necessary to be treated with hormonal drugs (prednisolone) in severe cases, with the bullous-hemorrhagic form, lymphostasis, and frequent relapses.
6. Traditional methods are used in combination, with a mild course.

Rules of application

When treating with antibiotics, you need to follow simple rules:

1. Antimicrobials are used strictly according to indications.
2. Prescribe only one drug to avoid cross-reactions.
3. To adequately treat the disease, you need to know the sensitivity of the bacteria to the drug (conduct a bacterial test + sensitivity to antibiotics).
4. Long-term treatment requires constant changes of drugs (preferably every week). This principle makes it possible to avoid microbial resistance to the drug.
5. The main condition for adequate treatment of erysipelas is complex therapy. It is necessary to take into account the interaction of different drugs.
6. It is better to influence the disease locally and systemically.
7. To prevent antibiotic-associated diarrhea, take probiotics (Enterozermina, Linex).

Contraindications

Antibiotics should not be taken in the following cases:

1. The patient has liver or kidney failure. Most drugs are eliminated through the kidneys and liver, which negatively affects the chronic process.
2. Individual intolerance to components. Penicillins are common culprits in allergies.
3. Pregnancy and lactation are a relative contraindication. When the risk for the mother is greater than for the fetus, medications are used in individual dosages (severe pneumonia, pyelonephritis, glomerulonephritis).
4. You can't drink alcohol. It interferes with the absorption of the drug, slows down its effect, and leads to severe dyspeptic syndrome (nausea, vomiting, upset stool).

Erysipelas is a disease that requires complex therapy. Neglected cases can be fatal. Be sure to consult a doctor for help. Independent, uncontrolled use of antibiotics will only worsen the situation.