Recurrent erysipelas despite antibiotic prophylaxis: an analysis from case studies.

BACKGROUND Erysipelas is a distinctive type of superficial cellulitis of the skin with prominent lymphatic involvement, generally caused by group A streptococci. A substantial proportion of patients experience recurrences of erysipelas, and this may be a reason to install prophylactic antibiotic treatment. Despite such prophylaxis, further recurrences are occasionally encountered. OBJECTIVES To investigate recurrences of erysipelas during prophylactic antibiotic treatment and to delineate the reasons for such failure. METHODS Retrospective chart review of 117 adult patients with episodes of erysipelas known in our institution between 1990 and 2004. RESULTS Recurrent episodes of erysipelas, despite prophylactic treatment, were found in eight patients. Our analysis indicated noncompliance, incorrect selection and insufficient dosing of antibiotics, and causative pathogens other than streptococci as demonstrable causes of the recurrence of erysipelas. In three patients, a reason for failure could not be identified. CONCLUSIONS In a minority of cases, erysipelas recurs despite antibiotic prophylaxis. Based on these cases, we first recommend that all efforts are made to (re)confirm the diagnosis of erysipelas and search for the causative microorganism. Based on this information, the right antibiotic with adequate dosing and timing can be selected. The issue of compliance with the prophylactic treatment should be addressed and finally, the clinician should be aware that prophylaxis does not prevent erysipelas in all cases.