Erythrasma medical therapy

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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., Suveenkrishna Pothuru, M.B,B.S. [2], Maliha Shakil, M.D. [3], Kalsang Dolma, M.B.B.S.[4]

Overview

The mainstay of erythrasma medical therapy is topical and systemic antibiotic therapy. The primary antibiotics used for local and widespread infection include fusidic acid, clindamycin, clarithromycin, and erythromycin, respectively. Additionally, there are studies that display efficacy of systemic administration of tetracycline and chloramphenicol. There is evidence that fusidic acid therapy is more effective than topical clarithromycin and systemic erythromycin, but may be indicated less due to poorer efficiency and patient compliance. Administration of chloramphenicol is limited due to its suppression of bone marrow and heightening risk of developing neutropenia, agranulocytosis and aplastic anaemia.

Medical Therapy

The mainstay of erythrasma medical therapy is topical and systemic antibiotic therapy. The primary antibiotics used for local and widespread infection include fusidic acid, clindamycin, clarithromycin, and erythromycin, respectively. Additionally, there are studies that display efficacy of systemic administration of tetracycline and chloramphenicol.

Antibiotic Regimen

• Erythrasma
  • Localized infection
    • Preferred regimen: Fusidic acid Topical bid or tid for 7-14 days
    • Alternative regimen : Clindamycin Topical bid or tid for 7-14 days
  • Widespread infection
    • Preferred regimen (1): Clarithromycin 500 mg PO bid for 14 days
    • Preferred regimen (2): Erythromycin 250 mgA PO bid for 14 days
    • Alternative regimen (1): Tetracycline 250 mgA PO bid for 14 days
    • Alternative regimen (2): Chloramphenicol 250 mgA PO bid for 14 days
      • Administration of chloramphenicol is limited due to its suppression of bone marrow and heightening risk of developing neutropenia, agranulocytosis and aplastic anaemia.
• There is evidence that fusidic acid therapy is more effective than topical clarithromycin and systemic erythromycin, but may be indicated less due to poorer efficiency and patient compliance.