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ulcers
• p haged enic ulcer ( in the early stages, antibio tics m ay be useful. T h ey are o ften
ineffective in the chro nic stages):
benzylpenicillin procaine + benzylpenicillin I M (if necessary give half the d o se in each
butto ck )
C hild ren: 1 0 0 0 0 0 I U / k g o nce d aily fo r 7 d ay s
A d ults: 4 M I U o nce d aily fo r 7 d ay s
If the p atient is allergic to p enicillin:
erythromycin P O
C hild ren: 5 0 m g/ k g/ d ay in 2 d ivid ed d o ses
A d ults: 2 g/ d ay in 2 d ivid ed d o ses
or
doxycycline P O (excep t in child ren und er 8 y ears and p regnant o r lactating wo m en)
C hild ren o ver 8 y ears: 4 m g/ k g o nce d aily
A d ults: 2 0 0 m g o nce d aily
or
metronidazole P O
C hild ren: 3 0 m g/ k g/ d ay in 3 d ivid ed d o ses
A d ults: 1 .5 g/ d ay in 3 d ivid ed d o ses
If after 7 d ay s the cho o sen antibio tic sho ws to be effective, co ntinue fo r as lo ng as
need ed , treatm ent d uratio n varies acco rd ing to the clinical evo lutio n.
F o r p atients treated with p enicillin, change to o ral treatm ent after 7 d ay s by using
phenoxymethylpenicillin P O
C hild ren fro m 1 to 5 y ears: 5 0 0 m g/ d ay in 4 d ivid ed d o ses
C hild ren fro m 6 to 1 2 y ears: 1 g/ d ay in 4 d ivid ed d o ses
A d ults: 2 g/ d ay in 4 d ivid ed d o ses
– T reat the cause
– C o m p lem entary therap y :
• E levate the legs in cases o f veno us and / o r ly m p hatic insufficiency
• G ive tetanus p ro p hy laxis if ap p ro p riate (see Tetanus, p age 1 7 0 )
• S k in graft 1if th e ulcer is extensive, clean, red and flat. S k in grafts are o ften
necessary after surgical excisio n to heal p haged enic and B uruli ulcers.
1 For techniques of skin grafting, refer to the MSF handbook, Minor surgical procedures in remote areas.
282
• p haged enic ulcer ( in the early stages, antibio tics m ay be useful. T h ey are o ften
ineffective in the chro nic stages):
benzylpenicillin procaine + benzylpenicillin I M (if necessary give half the d o se in each
butto ck )
C hild ren: 1 0 0 0 0 0 I U / k g o nce d aily fo r 7 d ay s
A d ults: 4 M I U o nce d aily fo r 7 d ay s
If the p atient is allergic to p enicillin:
erythromycin P O
C hild ren: 5 0 m g/ k g/ d ay in 2 d ivid ed d o ses
A d ults: 2 g/ d ay in 2 d ivid ed d o ses
or
doxycycline P O (excep t in child ren und er 8 y ears and p regnant o r lactating wo m en)
C hild ren o ver 8 y ears: 4 m g/ k g o nce d aily
A d ults: 2 0 0 m g o nce d aily
or
metronidazole P O
C hild ren: 3 0 m g/ k g/ d ay in 3 d ivid ed d o ses
A d ults: 1 .5 g/ d ay in 3 d ivid ed d o ses
If after 7 d ay s the cho o sen antibio tic sho ws to be effective, co ntinue fo r as lo ng as
need ed , treatm ent d uratio n varies acco rd ing to the clinical evo lutio n.
F o r p atients treated with p enicillin, change to o ral treatm ent after 7 d ay s by using
phenoxymethylpenicillin P O
C hild ren fro m 1 to 5 y ears: 5 0 0 m g/ d ay in 4 d ivid ed d o ses
C hild ren fro m 6 to 1 2 y ears: 1 g/ d ay in 4 d ivid ed d o ses
A d ults: 2 g/ d ay in 4 d ivid ed d o ses
– T reat the cause
– C o m p lem entary therap y :
• E levate the legs in cases o f veno us and / o r ly m p hatic insufficiency
• G ive tetanus p ro p hy laxis if ap p ro p riate (see Tetanus, p age 1 7 0 )
• S k in graft 1if th e ulcer is extensive, clean, red and flat. S k in grafts are o ften
necessary after surgical excisio n to heal p haged enic and B uruli ulcers.
1 For techniques of skin grafting, refer to the MSF handbook, Minor surgical procedures in remote areas.
282
