Fish-Handler's Disease (cont.)
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Antibiotics for Fish Handler’s Disease
Antibiotics to treat Fish-handler's disease are not always needed because some patients spontaneously clear the infection. However, if the infection with Erysipelothrix rhusiopathiae does not resolve then the antibiotics of choice are either penicillins or a cephalosporin such as ceftriaxone. Patients who are allergic to penicillin may be treated with ciprofloxin alone or with erythromycin in combination with rifampin (Rifadin). Rarely, a patient may develop endocarditis caused by this organism; IV forms of the above antibiotics are recommended for treatment. Vancomycin, a commonly used IV drug used to treat endocarditis will not be useful because Erysipelothrix rhusiopathiae is resistant to vancomycin. Clindamycin (Cleocin) has also been used effectively by IV.
For Mycobacterium spp. that cause Fish-handler's disease, patients may be treated with rifampin, streptomycin, sulfamethoxazole and trimethoprim (Bactrim), tetracyclines, isoniazid, pyrazinamide and/or ethambutol. Organisms isolated from the patient should be tested for drug susceptibility as some of these spp. are resistant to specific antibiotics. Mycobacterium spp. are difficult to treat; two antibiotics (or more) may need to be used to treat a patient. Some patients may need long-term antibiotics (about 18 months) and possibly surgical excision in addition to antibiotics to halt infection. Infrequently, a patient with Fish-handler's disease may require IV antibiotics.
Medically reviewed by Robert Cox, MD; American Board of Internal Medicine with subspecialty in Infectious Disease
Medically Reviewed by a Doctor on 5/20/2016
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