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terial skin infections
F or p atien ts allergic to p en icillin : erythromycin P O
C hild ren : 3 0 to 5 0 m g/ k g/ d ay in 3 d ivid ed d oses for 7 d ays
A d ults: 3 g/ d ay in 3 d ivid ed d oses for 7 d ays
– For all patients:
•Q uaran tin e from school.
•T reat an y p re- existin g sk in d isease: lice ( see p age 1 0 1 ) , scabies ( see p age 9 8 ) ,
ecz em a (see p age 1 1 7 ), herp es (see p age 1 1 6 ), scalp rin gw orm (see p age 1 0 4 ), or
an
E N T in fection (see C hap ter 2 ).
•T race an d treat con tacts.
•C heck for p rotein uria (use a reagen t strip ) 3 w eek s after the in fection .
Furuncles (boils) and carbuncle
A n ecrotisin g p erifollicular in fection , usually d ue to Staphylococcus aureus. D evelop m en t
is favoured by h um id ity, break s in th e sk in , lack of h ygien e, d iabetes m ellitus,
m aln utrition , iron d eficien cy or com p rom ised im m un ity.
Clinical features
– F urun cle: red , w arm , p ain ful n od ule w ith a cen tral p ustule, usually aroun d a hair
follicle. I t becom es fluctuan t, d isch arges a core of p urulen t exud ate, an d leaves a
d ep ressed scar. It occurs m ost freq uen tly on the thighs, groin , buttock s, arm p its, n eck
an d back . T here is n o fever.
– C arbun cle: a cluster of in tercon n ected furun cles, som etim es w ith fever an d
p erip heral ad en op athies. It leaves a d ep ressed scar.
Treatment
– F or a sin gle furun cle:
C lean w ith soap an d w ater 2 tim es/ d ay an d cover w ith a d ry d ressin g.
W arm m oist com p resses en courage furun cle to d rain .
A fter d rain age, clean an d ap p ly an an tisep tic un til the lesion has com p letely healed .
– F or furun cles on th e face, carbun cles, m ultip le furun cles ( furun culosis) or in
cimloxmacuillninoPcoOm p rom ised p atien ts, treat system atically w ith an tibiotics:
C hild ren : 5 0 m g/ k g/ d ay in 3 d ivid ed d oses for 7 d ays
A d ults: 3 g/ d ay in 3 d ivid ed d oses for 7 d ays
Feryotrhrpomayticeinn Pts Oallergic to p en icillin :
C hild ren : 3 0 to 5 0 m g/ k g/ d ay in 3 d ivid ed d oses for 7 d ays
A d ults: 3 g/ d ay in 3 d ivid ed d oses for 7 d ays
– E xcise the furun cle on ly w hen it becom es fluctuan t.
– F or all cases:
•F req uen t han d w ashin g, w ash bed d in g;
•N ever m an ip ulate a furun cle on the face as there is a risk of serious com p lication :
un ilateral facial in flam m ation w ith h igh fever an d risk of cavern ous sin us
throm bosis.
106
F or p atien ts allergic to p en icillin : erythromycin P O
C hild ren : 3 0 to 5 0 m g/ k g/ d ay in 3 d ivid ed d oses for 7 d ays
A d ults: 3 g/ d ay in 3 d ivid ed d oses for 7 d ays
– For all patients:
•Q uaran tin e from school.
•T reat an y p re- existin g sk in d isease: lice ( see p age 1 0 1 ) , scabies ( see p age 9 8 ) ,
ecz em a (see p age 1 1 7 ), herp es (see p age 1 1 6 ), scalp rin gw orm (see p age 1 0 4 ), or
an
E N T in fection (see C hap ter 2 ).
•T race an d treat con tacts.
•C heck for p rotein uria (use a reagen t strip ) 3 w eek s after the in fection .
Furuncles (boils) and carbuncle
A n ecrotisin g p erifollicular in fection , usually d ue to Staphylococcus aureus. D evelop m en t
is favoured by h um id ity, break s in th e sk in , lack of h ygien e, d iabetes m ellitus,
m aln utrition , iron d eficien cy or com p rom ised im m un ity.
Clinical features
– F urun cle: red , w arm , p ain ful n od ule w ith a cen tral p ustule, usually aroun d a hair
follicle. I t becom es fluctuan t, d isch arges a core of p urulen t exud ate, an d leaves a
d ep ressed scar. It occurs m ost freq uen tly on the thighs, groin , buttock s, arm p its, n eck
an d back . T here is n o fever.
– C arbun cle: a cluster of in tercon n ected furun cles, som etim es w ith fever an d
p erip heral ad en op athies. It leaves a d ep ressed scar.
Treatment
– F or a sin gle furun cle:
C lean w ith soap an d w ater 2 tim es/ d ay an d cover w ith a d ry d ressin g.
W arm m oist com p resses en courage furun cle to d rain .
A fter d rain age, clean an d ap p ly an an tisep tic un til the lesion has com p letely healed .
– F or furun cles on th e face, carbun cles, m ultip le furun cles ( furun culosis) or in
cimloxmacuillninoPcoOm p rom ised p atien ts, treat system atically w ith an tibiotics:
C hild ren : 5 0 m g/ k g/ d ay in 3 d ivid ed d oses for 7 d ays
A d ults: 3 g/ d ay in 3 d ivid ed d oses for 7 d ays
Feryotrhrpomayticeinn Pts Oallergic to p en icillin :
C hild ren : 3 0 to 5 0 m g/ k g/ d ay in 3 d ivid ed d oses for 7 d ays
A d ults: 3 g/ d ay in 3 d ivid ed d oses for 7 d ays
– E xcise the furun cle on ly w hen it becom es fluctuan t.
– F or all cases:
•F req uen t han d w ashin g, w ash bed d in g;
•N ever m an ip ulate a furun cle on the face as there is a risk of serious com p lication :
un ilateral facial in flam m ation w ith h igh fever an d risk of cavern ous sin us
throm bosis.
106
