Primary and secondary hospitalization criteria.

The reference therapy for erysipelas is penicillin G given intravenously. S ince I.V. injections are difficult to perform at home, hospitalization woul d seem mandatory. However, many cases of erysipelas are actually treated at home (cf. results of the 2 surveys concerning general practice). The lack of studies on non-hospitalized erysipelas patients makes it difficult to an swer the following question: "What are the criteria for primary and seconda ry hospitalization?" The literature suggests, mostly indirectly that the re asons of primary hospitalization are: the severity of general (fever, impai rment of general condition, confusion) or local (blisters, purpura, skin ne crosis, extent of the cellulitis, facial involvement) signs and symptoms, o ld age, associated diseases (diabetes, alcoholism, obesity, cardiovascular disease), the practical modalities of the treatment (penicillin given intra venously, bed rest), or the necessity to eliminate deep venous thrombosis. The reasons for secondary hospitalization are above all the (true or suspec ted) failure of oral antibiotherapy at home, or the occurrence of local com plications. True criteria of primary or secondary hospitalization remain to be defined by adequate prospective studies performed in both in and outpat ients. They will depend of the emerging possibilities of successfully treat ing erysipelas by oral antibiotics. (C) 2000 Editions scientifiques et medi cales Elsevier SAS.