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Erysipelas — RACP Adult Medicine MCQ

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HardInfectious DiseasesErysipelasRACP Adult Medicine

A patient has febrile, non-purulent erysipelas with a sharply raised border and no abscess or necrosis. Which empiric antimicrobial spectrum is appropriate?

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Correct answer: D — Use a beta-lactam active against beta-haemolytic streptococci, with route determined by severity

The best answer is “Use a beta-lactam active against beta-haemolytic streptococci, with route determined by severity”. Erysipelas is usually caused by beta-haemolytic streptococci, particularly Streptococcus pyogenes, and a narrow beta-lactam is appropriate when allergy and severity permit. Surface cultures are often unhelpful. Broader MRSA or Gram-negative coverage is reserved for purulence, penetrating trauma, specific exposures, severe immunocompromise or other risk factors.

Reference: Queensland Health: Cellulitis clinical pathway: https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/clinical-pathways/residential-aged-care-clinical-pathways/all-pathways/cellulitis