Dermatology Case No 23.Impetigo Crusty Lesion

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Dermatology Case No 23.Impetigo Crusty Lesion

রাফিদ, ৩ বছর বয়সের বাচ্চা, ওজন ১২ কেজি- তার মা তাকে নিয়ে আসছে চেম্বারে, তার মুখে নিম্নের ছবির মত crusty lesion,

অনেক চুলকায়, চিকিৎসা কি?

এইটার Dx হচ্ছে Impetigo, বাচ্চাদের ক্ষেত্রে most common একটা ব্যাকটেরিয়াল ইনফেকশন, staphylococcus aureus and streptococcus pyogen দিয়ে হয়ে থাকে এই ইনফেকশন –

জ্বর থাকতে পারে, সাথে ঠোঁটের আশেপাশে vesicular rash দেখা দেয়, ২৪-৪৮ ঘন্টার মধ্যে Vesicle গুলি Rupture হয়ে Crusty lesion হয়ে যায়, দেখতে হলদে dried honey like appearance, অর্থাৎ শুকনো মধুর মত দেখা যায়-

এই রোগ অনেক বেশি contagious, মুখের থেকে শরীরের দিকে, scalp, chest, trunk, hand, Finger ইনভলভ হতে পারে, পরিবারে অন্য ছোট বাচ্চা থাকলে তাদের মধ্যেও Transmit হতে পারে,

Impetigo সাধারণত বাচ্চাদের বেশি হয়৷ adult দের ক্ষেত্রে খুব একটা দেখা যায়না-

কিছু বাচ্চাদের impetigo lesions গুলি Bullous formation করে, তখন তাকে Bullous impetigo বলা হয়-

চিকিৎসা –

জ্বরের জন্য Paracetamol,

Syrup: Napa

১০ কেজি ওজনের জন্য দেড় চামচ দিনে ৩ বার

antihistamine – Syrup: Deslor (Desloratadine)

১০ কেজিরে আধা চামচ দিনে ১ বার

Topical Antibiotics cream: Bactrocin

আক্রান্ত স্থানে দিনে ২ বার (৭ দিন)

Ointment 1: Bactrocin 2% w/w 10gm tube (AS A Mupirocin Topical Antibiotic preparations).

Indications of Ointment : Bactrocin 2% w/w 10gm tube (AS A Mupirocin Topical Antibiotic preparations).

Bactrocin ointment is indicated for the topical treatment of impetigo (skin diseases) due to Staphylococcus Aureus and Streptococcus Pyogenes. It is also indicated in folliculitis, furunculosis.

Pharmacology of Ointment : Bactrocin 2% w/w 10gm tube (AS A Mupirocin Topical Antibiotic preparations).

Mupirocin is a naturally occurring antibiotic. It is an antibacterial agent produced by fermentation using the organism Pseudomonas fluorescens. It is active against a wide range of bacteria those responsible for the majority of skin infections, e.g. Staphylococcus aureus including methicillin-resistant Staphylococcus aureus (MRSA) other staphylococci and streptococci. It is also active against certain gram-negative pathogens, like Escherichia coli and Haemophilus influenzae. Mupirocin inhibits bacterial protein synthesis by reversibly and specially binding to bacterial isoleucyl transfer-RNA synthetase. Due to this unique mode of action, Mupirocin demonstrates no in vitro cross-resistance with other classes of antimicrobial agents. Mupirocin is bactericidal at concentrations achieved by topical administration. However, the minimum bactericidal concentration (MBC) against relevant pathogens is generally eight-fold to thirty-fold higher than the minimum inhibitory concentration (MIC).

Mupirocin is a naturally occurring antibiotic. This antibacterial agent is produced by fermentation using the organism Pseudomonas fluorescens. It is active against a wide range of bacteria (e.g. Staphylococcus aureus including methicillin-resistant strains and Streptococcus pyogenes) those responsible for the majority of skin infections. It is also active against gram-negative pathogens, such as Escherichia coli and Haemophilus influenzae. Mupirocin inhibits bacterial protein synthesis by reversibly and specifically binding to bacterial isoleucyl transfer-RNA synthetase.

Dosage & Administration of Ointment : Bactrocin 2% w/w 10gm tube (AS A Mupirocin Topical Antibiotic preparations).

A small amount of Bactropen ointment should be applied to the affected area 3 times daily for up to 10 days. The safety and effectiveness of Mupirocin ointment have been established in the age range of 2 months to 16 years.

Pediatric Use: The safety and effectiveness of Mupirocin have been established in the age range of 2 months to 16 years. Use of the ointment in these age groups is supported by evidence from adequate and well-controlled studies of Mupirocin in impetigo in pediatric patients.

Interaction of Ointment : Bactrocin 2% w/w 10gm tube (AS A Mupirocin Topical Antibiotic preparations).

No drug interaction has been identified with Bactrocin ointment.

Contraindications of Ointment : Bactrocin 2% w/w 10gm tube (AS A Mupirocin Topical Antibiotic preparations).

The drug is contraindicated in individuals with a history of hypersensitivity reactions to Mupirocin or any of the components of the preparation.

Side Effects of Ointment : Bactrocin 2% w/w 10gm tube (AS A Mupirocin Topical Antibiotic preparations).

Reported side effects are burning, stinging or pain, itching and some patient may be suffered rash, nausea, erythema, dry skin, tenderness, swelling, contact dermatitis and increased exudate.

Pregnancy & Lactation

Reproduction studies on Mupirocin ointment in animals have revealed no evidence of harm to the foetus. As there is no clinical experience on it’s use during pregnancy, Mupirocin ointment should only be used in pregnancy when the potential benefits outweigh the possible risks of treatment. It is unknown whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Mupirocin ointment is administered to a nursing woman.

Precautions & Warnings of Ointment : Bactrocin 2% w/w 10gm tube (AS A Mupirocin Topical Antibiotic preparations).

Bactrocin ointment is not for ophthalmic or intra-nasal use. As with other antibacterial products, prolonged use may result in overgrowth of non-susceptible organisms, including fungi. When Bactrocin is used on the face care should be taken to avoid the eyes. This is not suitable in conjunction with cannulae and at the site of central venous cannulation. In the event of a sensitization or severe local irritation from Bactrocin ointment, usage should be discontinued and appropriate alternative therapy for the infection instituted. Mixing of Bactrocin ointment with other preparations causes risk of dilution, resulting in a reduction of the antibacterial activity and potential loss of stability of the Bactrocin in the ointment.

Overdose Effects of Ointment : Bactrocin 2% w/w 10gm tube (AS A Mupirocin Topical Antibiotic preparations).

There is currently limited data with overdose of Bactrocin ointment. In the event of overdose, the patient should be treated supportively with appropriate monitoring as necessary.

Therapeutic Class of Ointment : Bactrocin 2% w/w 10gm tube (AS A Mupirocin Topical Antibiotic preparations).

Topical Antibiotic preparations

যদি severe impetigo হয়, তাহলে Oral antibiotics লাগতে পারে–

Flucloxacillin ( Fluclox DS)

Syrup 2:- Flubac DS 250mg/5ml 100ml Bottle (AS A Flucloxacillin Sodium AS A Penicillinase-resistant penicillins).

Indications of Syrup :- Flubac DS 250mg/5ml 100ml Bottle (AS A Flucloxacillin Sodium AS A Penicillinase-resistant penicillins).

Flubac DS is indicated for the treatment of infections due to Gram-positive organisms, including infections caused by penicillinase producing staphylococci. These indications include:

Skin and soft tissue infections: Boils, abscess, carbuncles, infected skin conditions (e.g. ulcer, eczema, acne, furunculosis, cellulitis, infected wounds, infected burns, otitis media and externa, impetigo).
Respiratory tract infections: Pneumonia, lung abscess, empyema, sinusitis, pharyngitis, tonsillitis, quinsy.
It is also used for the treatment of other infections i.e. osteomyelitis, enteritis, endocarditis, urinary tract infection, meningitis, septicaemia caused by Flubac DS-sensitive organisms.
As a prophylactic agent, it is used during major surgical procedures where appropriate; for example, cardiothoracic and orthopedic surgery.

Pharmacology of Syrup :- Flubac DS 250mg/5ml 100ml Bottle (AS A Flucloxacillin Sodium AS A Penicillinase-resistant penicillins).

Flucloxacillin is active against Gram-positive organisms including penicillinase producing strains. It has little activity against Gram-negative bacilli. Flucloxacillin acts by inhibiting the formation of cell wall of bacteria. Flucloxacillin is isoxazolyl penicillin which combined the properties of resistance to hydrolysis by penicillinase, gastric acid stability and activity against gram-positive bacteria. Flucloxacillin is a bactericidal antibiotic that is particularly useful against penicillinase-producing staphylococci. Flucloxacillin kills bacterial cellwall, thus interfering with peptidoglycan synthesis. Peptidoglycan is a heteropolymeric structure that provides the cell wall with its mechanical stability. The final stage of peptidoglycan synthesis involves the completion of the cross-linking with the terminal glycine residue of the pentaglycin bridge linking to the fourth residue of the pentapeptide (D-alanine). The transpeptidase enzyme that performs this step is inhibited by Flucloxacillin. As a result the bacterial cellwall is weakened, the cell swells and then ruptures. Flucloxacillin resists the action of bacterial penicillinase probably because of the steric hindrance induced by the acyl side chain which prevents the opening of the β- lactam ring.

Dosage of Syrup :- Flubac DS 250mg/5ml 100ml Bottle (AS A Flucloxacillin Sodium AS A Penicillinase-resistant penicillins).

Oral administration:

Adult: 250 mg four times daily. Dosage may be doubled in severe infections. In osteomyelitis and endocarditis, up to 8 gm daily is used in 6-8 hourly divided doses.
Children (2-10 years): 1/2 of adult dose.
Children (Under 2 years): 1/4 of adult dose.

Parenteral administration:
Adult or Elderly:

Intramuscular Injection: 250 mg four times daily.
Intravenous Injection: 250 mg-1 g four times daily by slow injection over 3 to 4 minutes or by intravenous infusion.
All systemic doses may be doubled in severe infections: doses up to 8 g daily have been suggested for endocarditis or osteomyelitis.

Children:

2-10 years: half of the adult dose.
Under 2 years: a quarter of the adult dose.

Administration of Syrup :- Flubac DS 250mg/5ml 100ml Bottle (AS A Flucloxacillin Sodium AS A Penicillinase-resistant penicillins).

Oral doses should be administered 1 hour before meal.

Interaction of Syrup :- Flubac DS 250mg/5ml 100ml Bottle (AS A Flucloxacillin Sodium AS A Penicillinase-resistant penicillins).

Concurrent use of Flubac DS and may result in increased level of Flubac DS in blood for prolonged period.

Contraindications of Syrup :- Flubac DS 250mg/5ml 100ml Bottle (AS A Flucloxacillin Sodium AS A Penicillinase-resistant penicillins).

Flucloxacillin is contraindicated in penicillin hypersensitive patients.

Side Effects of Syrup :- Flubac DS 250mg/5ml 100ml Bottle (AS A Flucloxacillin Sodium AS A Penicillinase-resistant penicillins).

There have been some common side effects of gastrointestinal tract such as nausea, vomiting, diarrhoea, dyspepsia and other minor gastrointestinal disturbances. Besides these rashes, urticaria, purpura, fever, interstitial nephritis, hepatitis and cholestatic jaundice have been reported.

Pregnancy & Lactation of Syrup :- Flubac DS 250mg/5ml 100ml Bottle (AS A Flucloxacillin Sodium AS A Penicillinase-resistant penicillins).

US FDA Pregnancy Category of Flucloxacillin is B. There are, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Flucloxacillin have been shown to be excreted in human milk. So, caution should be exercised when Flucloxacillin is administered to a lactating mother.

Precautions & Warnings of Syrup :- Flubac DS 250mg/5ml 100ml Bottle (AS A Flucloxacillin Sodium AS A Penicillinase-resistant penicillins).

Flubac DS should be used with caution in patients with evidence of hepatic dysfunction. Caution should also be exercised in the treatment of patients with an allergic diathesis.

Use in Special Populations of Syrup :- Flubac DS 250mg/5ml 100ml Bottle (AS A Flucloxacillin Sodium AS A Penicillinase-resistant penicillins).

In severe renal failure (creatinine clearance <10 ml/min), a reduction in dose or an extension of dose interval should be considered.

Therapeutic Class of Syrup :- Flubac DS 250mg/5ml 100ml Bottle (AS A Flucloxacillin Sodium AS A Penicillinase-resistant penicillins).

Penicillinase-resistant penicillins

১০ কেজিতে ১ চামচ করে দিনে ৪ বার

চিকিৎসা নিলে ৭ দিনেই এই রোগ ভালো হয়ে যায়-

Raiyyan Tahsan Date:25-01-2025 Saturday Time:6-25-45 PM

Raiyyan Tahsan

Raiyyan Tahsan