Treatment of Erysipelas with Penicillin Allergy: Infection Near the Eyes or Nose in Adults

Adults aged 18 and over with erysipelas located near the eyes or nose require careful antibiotic selection. When penicillin allergy is documented — or co-amoxiclav is otherwise unsuitable — the standard first-line options are not available, and an alternative regimen is indicated.

Clinical Scenario

Adults aged 18 and over · Erysipelas with infection near the eyes or nose · Penicillin allergy or co-amoxiclav unsuitable

Treatment Approach

In this specific situation, a combination antibiotic regimen is recommended, with the option to administer treatment orally or intravenously depending on the person's clinical condition. Specialist advice should be considered. The complete antibiotic selection, sequencing, route guidance, and full dosing protocol are available via the structured evidence-based regimen.

Clinical Goals

Symptoms are expected to start improving within 2 to 3 days. Seek medical help if symptoms worsen rapidly or do not begin improving in that window. Full resolution of symptoms at 5 to 7 days is not expected — skin takes time to return to normal.

Instant Access to Structured Evidence-Based Regimens

References

table 1 for adults aged 18 years and over
Alternative first-choice antibiotics if infection is near the eyes or nose for penicillin allergy or if co-amoxiclav is unsuitable (consider seeking specialist advice; give orally unless person unable to take oral or severely unwell)
Clarithromycin (7 days): 500 mg twice a day orally or 500 mg twice a day intravenously
with Metronidazole (7 days): 400 mg three times a day orally or 500 mg three times a day intravenously
seeking medical help if symptoms worsen rapidly or significantly at any time, or do not start to improve within 2 to 3 days.
However, skin does take some time to return to normal, and full resolution of symptoms at 5 to 7 days is not expected.

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