Gram-Negative Toe Web Infection

Aka: Gram-Negative Toe Web Infection, Tinea Pedis Superinfection, Interdigital Intertrigo Secondary Infection, Bacterial Intertrigo of Toe Webspace

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II. Causes

  1. Gram Negative infections (most common)
    1. Pseudomonas aeruginosa
    2. Moraxella
    3. Alcaligenes
    4. Acinetobacter
    5. Erwinia
  2. Gram Positive infections (part of mixed-infection)
    1. Group A Beta Hemolytic Streptococcal Cellulitis
    2. Staphylococcus aureus
    3. Staphylococcus saprophyticus

III. Risk Factors

  1. Obesity
  2. Diabetes Mellitus

IV. Symptoms

  1. Burning in toe webspace

V. Signs

  1. Initially mild erythema
  2. Later, marked erythema, maceration, odor
  3. Pustular discharge from site

VI. Management

  1. Consider Debridement
  2. Consider hospitalization (severe case, comorbidity)
  3. Antibiotics (cover for Gram Negatives, Pseudomonas)
    1. Ciprofloxacin 500 mg PO bid for 10 days
    2. Ceftazidime 500 to 1000 mg IV or IM q8 hours
    3. Cefotaxime 1 gram IV or IM q12 hours
      1. Does not cover Pseudomonas
    4. Amikacin gel 5% applied to area
  4. Adjunctive measures
    1. Acetic acid 2-5% (Burrow's Solution)
      1. Applied to area as warm compress

VII. References

  1. Habif (2004) Clinical Dermatology, p. 413
  2. Janniger (2005) Am Fam Physician 72(5):833-8 [PubMed]

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