Staph Infections

DermatologyInfections

25 Feb

Written By Maladywise

Boils (furuncle) and abscesses (carbuncle)
- Most can be treated with incision and drainage alone
- Antibiotics only help if significant cellulitis (skin redness spreading away from the lesion)
  - Adults
    - Di/Flucloxacillin 500mg four times daily for 6 days OR
    - Cephalexin 500mg four times a day for 5 days (can do 1g twice daily if easier)
  - Kids
    - Di/Flucloxacillin 12.5mg / kg up to 500mg four times a day for 6 days OR
    - Cephalexin 12.5mg / kg up to 500mg for 5 days (can do 25mg /kg twice daily if easier)
      - Cephalexin better tolerated due to taste
Impetigo / School Sores
- If localised skin sores then Mupirocin 2% (Bactroban) ointment or cream 3 times a day for 7 days
- If multiple skin sores then use antibiotics listed above

Aggressive strains of bacteria (usually Staph) are responsible for recurrent infections
These may reoccur over many months
Generally there is no detectable problem with a persons immune system
Eventually the body develops immunity but this may take up to 2 or 3 years
Any small abrasion (e.g. shaving skin) or wound can be a source of entry for bacteria
Spread of infection is common within sporting clubs, daycare, prisons, nursing homes, schools and crowded areas

Generally avoid antibiotics unless you have a serious infection
Improve your skin condiition
Hygienic management of cuts and scratches
Avoid shaving of skin especially of arm pits (use clippers or electric razor) if boils have occurred there

Treat any associated scabies, eczema, psoriasis, tinea, skin trauma from shaving or scratching
Routine skin care

Use an antiseptic cleanser
- Triclosame 1% or chlorhexidine 2% e.g. Phisohex skin cleanser, Microshield skin cleanser
- Apply generous to entire body surface including scalp or hair, avoiding eyes
- Leave on for at least 3 minutes before rinsing well
- Use daily for 1 week then back to 2 to 3 times a week maintenance
Consider a bleach bath instead of the antiseptic cleanser if easier
- Fill the bath using a 10L bucket to your desired bath level
- Count the number of buckets used and then mark the bath with tape so you don’t have to use buckets next time
- Add 12mL of unscented housebhold bleach for every 10L bucket
  - 4.2% sodium hypochlorite bleach e.g. White King
  - Final bleach concentration of 0.005% which is very low and shouldn’t cause any problems
- Soak in bath for 10 minutes
- Wash head and face with bath water
- Wipe away crusting for weeping at infected areas with a soft disposable towel (e.g. a Chux type cloth)
- Do not rinse skin after bath
- Use a fresh towel with each bath but use old white towels to avoid bleaching of coloured towels
- For recurrent staph or impetigo
  - Repeat bleach baths once daily for 5 days
  - After that can do once or twice weekly for maintenance until infections have settled

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