Penicillin G (1-2 million units IV q6h) may be used in nondiabetic patients for initial treatment due to the high incidence of streptococcal infection. Penicillinase-resistant penicillins (nafcillin or oxacillin 2 g IV q4h), parenteral second- or third-generation cephalosporins (ceftriaxone 1-2 g IV qd), or amoxicillin-clavulanate (875/125 mg PO q12h) should be used in diabetic patients and those with facial disease. Imipenem (500 mg IV q6h) is recommended in severe cases. Erythromycin, cephalosporins, or a macrolide should be used in patients with penicillin allergy. Essentially all patients with erysipelas should be admitted to the hospital for intravenous antibiotics.

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