Low-dose amoxicillin as prophylaxis for recurrent erysipelas: Is it the answer?

Background

While erysipelas recurrence remain high, relapse rates have been shown to decrease using oral penicillin V or intramuscular benzathine penicillin. However, a significant number of patients encounter pain or contraindications to IM injections, and oral penicillin is no longer available in Belgium.

Methods

The objective of our study was to retrospectively analyze, in a non-comparative single-center cohort, the outcomes of patients with recurrent erysipelas having received amoxicillin (1 g/day) as an alternative prophylactic antibiotic.

Results

Twenty-six patients were included. Mean age was 58.7 years, with male predominance (69.2%). The erysipelas incidence rate prior to amoxicillin prophylaxis was 4.5 episodes/patient-year. Following the introduction of amoxicillin prophylaxis, the incidence rate fell to 0.15 episode/patient-year (p < 0.001). Even though this represented a 66% reduction, the small sample size limits generalizability. Mean follow-up duration was 44.58 months. Amoxicillin was discontinued in 15 patients (57.7%), of whom eight (53.3%) relapsed. During amoxicillin treatment and after withdrawal, there occurred no severe side effect such as allergic reaction, gastrointestinal event, mycosis, Clostridioides difficile infection, or colonization or infection by multidrug-resistant bacteria.

Conclusion

This study suggests that at a preventive dose, amoxicillin is well-tolerated, reducing the incidence of erysipelas, possibly representing a viable therapeutic option for patients with contraindication, intolerance, or limited access to first-line prophylaxis (intramuscular or oral penicillin). Given the small sample size and the absence of a comparator arm, comparative studies are needed to confirm the potential equivalence of amoxicillin with penicillin V.