What is the initial treatment of choice for Facial Erysipelas?

The initial treatment of choice for facial erysipelas is oral penicillin. Erysipelas is a superficial skin infection primarily caused by Streptococcus pyogenes. Oral penicillin is effective because it targets these bacteria specifically, providing an appropriate antibiotic coverage. If patients are allergic to penicillin, alternative antibiotics such as cephalexin or clindamycin are commonly used.

Intravenous cefazolin is typically reserved for more severe infections requiring hospitalization or for patients who cannot take oral medications. Topical clindamycin would not be adequate for treating a systemic infection like erysipelas, which usually requires systemic antibiotics. Intravenous vancomycin is also more relevant in cases where resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) are suspected, but this is not common in typical facial erysipelas cases caused by streptococci.

Thus, oral penicillin remains the first-line treatment due to its efficacy against the usual pathogens involved, its appropriate route of administration, and its safety profile.