Erysipelas secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.


Secondary prevention for erysipelas is antibiotic prophylaxis for severe cases with high likelihood of recurrence. Phenoxymethylpenicillin, erythromycin, and benzathine penicillin have all displayed varying levels of efficacy in preventing erysipelas recurrence. More research is needed to determine standardized antibiotic selection, dosing, and interval of administration for universal application.

Secondary Prevention

The mainstay of erysipelas secondary prevention is antibiotic prophylaxis for severe cases with high frequency of recurrence.

  • Phenoxymethylpenicillin or erythromycin are indicated for prophylaxis for those with severe cases and predisposition to the disease, such as venous insufficiency.[1]
  • Research on the efficacy of antibiotic prophylaxis of erysipelas is not conclusive for complete prevention of recurrence.[2]
    • Benzathine penicillin, administered intravenously every 3 weeks for 6 months at 2.4 MU, prevented recurrence during treatment, but cessation of therapy prompted the recurrence of erysipelas for 25% of patients.[3]
    • Erythromycin was shown to be effective prophylaxis throughout administration.[1][4]
    • A randomized controlled trial of phenoxymethylpenicillin and erythromycin were shown to reduce erysipelas recurrence in patients with venous insufficiency or lymphatic congestion, but relapse still occurred in 10% of the patients in the the treatment arm.[5]
  • Efficacy of prophylaxis is dependent on dose volume, time interval of administration, and accurate identification and specification of the pathogen.[5][2]
    • Consensus for penicillin concentrations and frequency sufficient for prophylaxis is not yet established.[2]
      • More research is needed to determine the efficacy of administration every second week and every third week.
      • Doubling the dosage of Benzathine penicillin administered (usually 1.2 MU) may provide longer and more effective prophylaxis.


  1. 1.0 1.1 Jorup-Rönström C, Britton S (1987). "Recurrent erysipelas: predisposing factors and costs of prophylaxis". Infection. 15 (2): 105–6. PMID 3110071.
  2. 2.0 2.1 2.2 Koster JB, Kullberg BJ, van der Meer JW (2007). "Recurrent erysipelas despite antibiotic prophylaxis: an analysis from case studies". Neth J Med. 65 (3): 89–94. PMID 17387234.
  3. Duvanel T, Mérot Y, Harms M, Saurat JH (1985). "Prophylactic antibiotics in erysipelas". Lancet. 1 (8442): 1401. PMID 2861358.
  4. Kremer M, Zuckerman R, Avraham Z, Raz R (1991). "Long-term antimicrobial therapy in the prevention of recurrent soft-tissue infections". J. Infect. 22 (1): 37–40. PMID 2002231.
  5. 5.0 5.1 Sjöblom AC, Eriksson B, Jorup-Rönström C, Karkkonen K, Lindqvist M (1993). "Antibiotic prophylaxis in recurrent erysipelas". Infection. 21 (6): 390–3. PMID 8132369.

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