Cellulitis / Diabetic Foot / Skin infection (general) - IDSA Guideline Based

Question 1

Impetigo (bolus and non-bolus) suggested treatment

Answer 1

Oral or topical antimicrobials BUT oral therapy is recommended for individuals with numerous lesions or in outbreaks affecting several people

Question 2

Most common pathogen in non-bollus impetigo

Answer 2

S aureus (most common) followed by GAS

Question 3

Bollus impetigo main cause?

Answer 3

S. Aureus

Question 4

What is bollous impetigo?

Answer 4

Bollus impetigo DOES NOT form a honey coloured crust, most commonly arises in skin folds and trunk

Question 5

What is non-bollous impetigo?

Answer 5

Usually around mouth region, more lesions then bollous impetigo and FORMS A HONEY COLOURED CRUST

Question 6

Initial impetigo therapy

Answer 6

Usually topical unless many lesions or otherwise needed (another card covers this)

Mupirocin 2% ointment TID F-7D
Retapamulin 1% ointment BID F5D
Fusidic acid 2% cream TID until healed or UP TO 14 days

Question 7

ISDA treatment length for ecthyma or impetigo using oral therapy?

Answer 7

7 days

Question 8

oral therapy suggested for impetio or ecthyma

Answer 8

Need coverage for S aureus unless you culture specifically only streptococci (in which case you can use oral penicillin)

OTHERWISE:
Dicloxacillin 250mg QID (ive never seen this in canada)
Clindamycin
TMP/SMX
cephalexin 250mg QID, 25-50mg/kg/day TID/QID for kids

Question 9

What to do first with an absece and carbuncle and large funruncles?

Answer 9

Incision and drainage

Question 10

When to start antibioitcs aimed at MRSA for purulent SSTIs after incision and drainage?

Answer 10

No need in mild
Signs and symptoms of fever (>38F temp) tachypnea, tachycardia, WBC increasing
Also target MRSA if carbuncle or abscess patients have failed initial abio treatment

Question 11

MSSA SSTI treatment options

Answer 11

Nafcillin or oxacillin (never seen this so wont supply dosing)
Cefazolin 1g Q8H IV
Clindamycin 600mg Q8H or 300-450 QID PO
Dicloxacillin 500mg QID PO
Cephalexin 500mg QID PO
Doxycyclin/minocyclin 100mg BID PO
TMP/SMX 1-2 DS tabs BID PO
other then TMP/CMX most therapies are 25mg/kg/d either QID or TID as a minimum for kiddo dosing

Question 12

MRSA SSTI treatment options

Answer 12

Vancomycin 30mg/kg/d BID IV
Linezolid 600mg Q12H IV or 600mg BID PO
Clindamycin 600mg Q8H IV ro 300mg-450mg QID PO
Daptomycin 4mg/kg Q24H
TMP/SMX 1-2 DS BID PO

Question 13

Reccurent abcess treatment duration?

Answer 13

5-10 day course

Question 14

Typical cellultis treatment goal for non systemic cases (no fever)

Answer 14

Target streptococci

Question 15

For cases of cellultiis with systemic symptoms what are we worried about?

Answer 15

Some clinicians are worried about MRSA

Question 16

Times to worry about MRSA in celliulitis?

Answer 16

IVDU, penetrating trauma, MRSA colonized, severe non purulent

Question 17

Severe non purulent cellultis treatment option?

Answer 17

Coverage for MRSA + streptococci is recommended

Vanco + meropenem/imipenem or vanco + pipercillin-tazobactam

Question 18

Non pharm recommendations in cellultis

Answer 18

Elevation of affected area

Question 19

Are anti-inflammatory agents useful in cellultiis?

Answer 19

Corticosteroids (systemic) can be used ie Pred 40mg F7D) in nondiabetic patients with cellultiis

Question 20

Options for prophylaxis in reccurnt cellultis?

Answer 20

oral penicillins or erythromycin BID F4-52W or intramuscular benzathine penicllin Q2-4W if 3-4 cellultiis episodes per year

Question 21

Necrotyzing fascitis treatment options

Answer 21

empiric abio options:

Vancomycin or linezolid + pipercillin-tazobactam or meropenem/imemenem or ceftriaxone and metronidazole

Question 22

Diabetic foot infection classification GENERAL severity scaling

Answer 22

uninfected if > 2 of the following:
Local swelling or induration, erythema, local tenderness or pain, local warmth or purulent discharge

Mild = just skin involvement and nothing very far from ulcer

moderate = skin >2 cm from ulcer involved or deeper then skin

Severe = SIRS signs (systemic inflmmatory response) ie fever elevated HR, WBC increasing etc etc

Question 23

Do we culture diabetic foot wounds?

Answer 23

IDSA suggests that almost all INFECTED diabetic foot wounds be cultured

MAKE SURE THE AREA IS DEBRIDED FIRST

ALSO YOU CULTURE FROM A STERILE SCAPLE NOT SWAB

Question 24

MILD diabetic foot empiric treatment

Answer 24

suspected cause: MSSA dicloxacillin, clindamycin, cephalexin QID, levofloxacin OD, amoxi-clav

MRSA: Doxycycline, TMP/SMX

Question 25

Moderate diabetic wound empiric treatment

Answer 25

suspecting MSSA:
Levofloxacin
Ceftriaxone
Ampicillin-sulbactam (only use if not suspecting P. aerugonosa)
Moxifloxacin, ertapenem, levo or cipro w/ clinda

MRSA: Vanco is the big one, can also consider linezolid (caution w/ >2w treatment) and dapto

P. aeruginosa: Pipercillin tazobactam TID/QID

Question 26

Abio course for diabetic foot?

Answer 26

1-2 weeks for mild

2-3 for mod to severe