Secondary Infection

It is not uncommon, particularly in children, for any eczema to become secondarily infected. The Staphylo­coccus aureus and the beta hemolytic streptococcus are the most common or­ganisms. Infection is manifested by pustules, which may be few or many, and which occur on the normal as well as on the eczematous skin. Siich in­fection is now, as a rule, more easily cured than is the original eczema. Although it is true that many strains of staphylococcus are resistant to penicillin in vitro, it has seemed to me that this almost always works well against secondary skin infection, no matter if the infecting organism be a staphylococcus or a streptococcus. Furthermore, it works when given by mouth, and large doses are not necessary. I have usually given 300,000 units a day to a baby and 400,000 to a child: the soluble tablets to a baby, and buffered tablets to a child. It is well to continue the peni­cillin for about a week after the pustules have gone, in order to pre­vent recurrence. Theoretically, the broad spectrum antibiotics should work better-practically speaking, I doubt if they do.

For local treatment of large exuda­tive areas of infection, wet dressings of potassium permanganate solution 1 to 8,000 are used: for smaller areas, where not much of the active drug will be absorbed, wet dressings of 0.25 per cent silver nitrate solution. For small, slightly oozing, impetigi-nous spots, or oozy broken pustules, I have always had good results with Alulotion* sopped on frequently. This is a colloidal ammoniated mer­cury preparation with kaolin and aluminum hydroxide gel. In addi­tion to its strong antiseptic action it is also astringent-it dries up and shrinks small, wet lesions. For large areas that are not exudative I have used neomycin, bacitracin, or “E r y t h r o-Myciguent”** ointments. All of them are good-I have been unable to see that one is any better than the other.

Fresh underclothes should be worn every day and boiled before washing, the fingernails should be kept short and scrubbed two or three times a day, as the spread of secondary in­fection is largely brought about by autoinoculation from scratching. Ammoniated mercury  ointment (3 per cent) is still a good skin anti­septic, and I suspect that the greatly improved results in the treatment of skin infection in recent years are due more to the internal administration of the antibiotic than to great superiority of any one of them over am-moniated mercury when applied locally.

*Wyeth   Incorporated,   Philadelphia.
**The   Upjohn   Co.,   Kalaraazoo,   Mich.