Therapy | Dose, Route, and Duration of Therapy |
Antibiotics and Antivirals | Penicillin 500 mg twice daily, cephalosporin 500 mg four times daily, or clindamycin 150 mg four times daily. Acyclovir 800 mg five times daily. Continue until area has epithelialized. |
Nitroglycerin paste 2% | Apply immediately around injection site and zone of ischemia for 5 minutes. Reapply for 5 minutes every 1 - 2 h while in the ED, but for no longer than 24 h due to development of drug tolerance. |
Corticosteroids | Oral prednisone 60 mg daily for 4 d, or methylprednisolone dose pack for 6 d. |
Enoxaparin | 30 mg subcutaneously every 12 h for 7 - 14 d or until area has normal arterial blood flow; do not give in combination with acetylsalicylic acid aspirin. |
Acetylsalicylic acid aspirin | 325 mg orally once daily for 7 - 14 d; do not give in combination with enoxaparin. |
Esomeprazole | 40 mg daily for 5 d. |
Phosphodiesterase type 5 inhibitors | Oral sildenafil 100 mg, tadalafil 20 mg, or vardenafil 100 mg daily for 7 - 14 d or until area has normal arterial blood flow. |
Hyperbaric oxygen | Begin treatment daily as soon as possible, with continued treatment at 3 atmospheres for 45 minutes daily until the area has epithelialized. |