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.