[The practice guideline 'Bacterial skin infections' (first revision) from the Dutch College of General Practitioners; a response from the perspective of dermatology].
We reviewed the first revision of the clinical practice guidelines on the management of bacterial skin infections developed by the Dutch College of General Practitioners. Bacterial skin infections are subdivided into superficial and deep infections; the former are often treated locally while the latter may require systemic antibiotics or surgical intervention. The rate of infection with methicillin-resistant Staphylococcus aureus (MRSA) in the community is relatively low in The Netherlands, but the guideline provides recommendations, such as the restricted use of mupirocin ointment, to facilitate future MRSA control measures. Clinical distinction between erysipelas and cellulitis is often impossible; therefore, the term cellulitis is used throughout the guideline and refers to both Staphylococcus aureus and Streptococcus pyogenes infections of the skin and subcutaneous tissue. The first line of therapy for cellulitis remains a small spectrum, beta-lactamase resistant penicillin, such as flucloxacillin for 10 days. There are no conclusive studies on the prevention of recurrent cellulitis, so recommendations are based on expert opinion and pathophysiological considerations. The lack of rigorous and controlled studies often precludes making clear evidence-based recommendations. However, this guideline succeeds remarkably well in combining the available evidence and formulating sound practical management advice for bacterial skin infections in primary care in The Netherlands. It deserves widespread implementation among general practitioners.
Sanders
C J G
CJ
Universitair Medisch Centrum Utrecht, afd. Dermatologie en Allergologie, Huispost G02.124, Heidelberglaan I00, 3584 CX Utrecht. c.sanders@umcutrecht.nl
Bruijnzeel-Koomen
C A F M
CA
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D003880:Dermatology / Q000592:standards*; D004886:Erysipelas / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D004890:Erythema / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007169:Impetigo / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D055624:Methicillin-Resistant Staphylococcus aureus; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D012955:Societies, Medical; D013207:Staphylococcal Skin Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
D000900:Anti-Bacterial Agents