Cellulitis, Osteomyelitis Flashcards
Non MRSA Cellulitis treatment
Penicillin G (if definitively streptococcal)
Cefazolin/cephalexin
Ceftriaxone
Clindamycin
Empiric MRSA coverage needed for cellulitis with these factors
Penetrating trauma
IVDU
Purulent drainage
Nasal colonization with MRSA
Evidence of MRSA elsewhere or SIRS w/ nonpurulent cellulitis
Outpatient empiric MRSA therapy for cellulitis
Clindamycin
Bactrim (+ B lactam to cover streptococcus)
Doxycycline (+ B lactam to cover streptococcus)
Inpatient empiric MRSA therapy cellulitis
Vancomycin
Linezolid
Daptomycin
Telavancin
Treatment duration for celluitis
5-10 days
Erysipelas
Skin infection that spreads through lymphatic system in skin
Usually occurs in infants, older adults
Warmth, erythema, pain
Edge of infection is elevated and sharply demarcated
Systemic signs common but blood culture rarely positive (5%)
Erysipelas common organism
Group A Streptococcus (G, C, B also seen)
Erysipelas treatment
Penicillin G
Cefazolin
Clindamycin
5 days
Necrotizing fasciitis
Involves subcutaneous fat and superficial fascia
Severely alters surrounding tissue, leads to gangrene or cuteanous anesthesia
Streptococcol nec fasc
Streptococcus pyogenes (type 2)
Spontaneous
Varicella
Minor trauma (cuts, burns splinters)
Surgical procedure
Mixed infection nec fasc
Facultative and anaerobic bacteria (type 1)
Secondary infection to:
Perianal abscess
Abdominal surgery
Trauma
Decubitus ulcer
IVDU
Most important part of nec fasc treatment
Surgical debridement
Empiric ABX therapy for nec fasc
Vancomycin or linezolid
PLUS
Zosyn or carbapenem or ceftraixone + metronidazole
If GAS, S. aureus, or Clostridium spp suspected:
Add Clindamycin or linezolid
Clindamycin and LInzeolid in nec fasc
Suppress toxin and cytokine production
Streptococcal nec fasc treatment
High dose IV penicillin
PLUS
Clindamycin or linezolid
Varicella cellulitis
Maculopapules, vesicles, scabs with clear fluid. On trunk/face then spread elsewhere
- Acyclovir 800mg PO 4-5 times daily x5 days
- Valacyclovir 1g PO TID x5-7 days
Diabetic Foot Infection organisms
Polymicrobial
S. aureus, GAS, GBS, Enterococcus, Proteus, E. coli, Klebsiella, Enterobacter, P aeruginosa, Bacteroides, Peptostreptococcus
Mild Diabetic Foot Infection
Local infection involving only the skin and subcutaneous tissue. No SIRS criteria. Erythema of 2cm or less
No antibiotics in the past month
Mild DFI treatment, no MRSA risk factors
Dicloxacillin
Nafcillin
Oxacillin
Cephalexin
Cefazolin
Levofloxacin
Doxycycline
Bactrim (if sulfa allergy)
Moxifloxacin
Clindamycin
Mild DFI treatment, high risk for MRSA
Previous MRSA infection or colonized
Linezolid
Cilndamycin
Doxycyline
Bactrim
Moderate to severe DFI definition
Local infection with erythema > 2cm OR
involves structures deeper than skin & subcutaneous tissue w/ or w/o SIRS criteria
Moderate to severe DFI treatment
Unasyn
2nd or 3rd generation cephalosporins (cefuroxime, cefotaxime, ceftriaxone)
Moderate to severe DFI treatment if recent antibiotics
Zosyn
2nd or 3rd generation cephalosporins
Ertapenem
Moderate to severe DFI treatment if macerated ulcer or warm climate
Zosyn
Dicloxacillin or nafcillin or oxacillin PLUS ceftazidime or ciprofloxacin
Meropenem
Imipenem
Moderate to severe DFI if ischemic limb/necrosis/gas forming
Augmentin
Unasyn
Zosyn
Moderate to severe DFI if risk for gram-negative organisms
Ertapenem
Meropenem
Imipenem
Ciprofloxacin
Aminoglycoside
Polymyxin
Moderate to severe DFI if risk of MRSA
Risks: prolonged hospitalization, ICU admit, recent hospitalization, recent ABX use, invasive procedure, HIV, nursing home, open wound, hemodialysis, discharge w/ long-term central venous access
Vancomycin
Linezolid
Doxycycline
Bactrim
Daptomycin
DFI treatment duration
1-2 weeks, can prolong 3-4 weeks if slow response, severe PAD
6 weeks if osteomyelitis
DFI treatment duration if amputation needed
2-5 days post op if no remaining infected tissue/bone
1-2 weeks if residual infected tissue
3 weeks if residual infected bone
Empiric osteomyelitis treatment for children
Cefazolin
Nafcillin/oxacillin
If MRSA community prevalence is >10%:
Clindamycin
Vancomycin (if high resistance to clindamycin)
Empiric osteomyelitis treatment for adults
Gram - coverage (cefazolin, ceftriaxone, cefepime, meropenem)
+
Anti-staph agent (clindamycin, doxycycline, vancomycin, linezolid, daptomycin)
Empiric osteomyelitis treatment for sickle cell patients
High risk for Salmonella
Ceftriaxone/cefotaxime
OR
ciprofloxacin/levofloxacin
Osteomyelitis with prosthetic joint & retention of prosthesis or one-stage exchange
Staph: staph coverage + rifampin 300-450mg BID x2-6 weeks
THEN
rifampin + cipro/levo for 3-6 months
If no staph, then IV or PO tx for 4-6 weeks, followed by indefinite oral suppression therapy
Osteomyelitis with prosthetic joint and removal of prosthesis
IV or PO therapy x4-6 weeks
Osteomyelitis treatment duration if amputation
If all infected tissue removed: 24-48 hours
Acute osteomyelitis treatment duration
3-6 weeks
Chronic osteomyelitis treatment duration
6-8 weeks IV or PO abx
May extend if high risk of failure (MRSA, extensive infection)
Osteomyelitis criteria to switch to PO
- Highly bioavailable PO abx available
- PT can be adherent
- Identified organism is highly susceptible to PO abx
- C-reactive protein <2.0
- Adequate surgical debridement
- Resolving clinical course
Impetigo mild treatment
Topical mupirocin or retapamulin ointment for 5 days
Mild = focal and few lesions
Impetigo oral treatment
If ecthyma or multiple lesions, outbreak
MSSA: dicloxacillin, cephalexin
MRSA: bactrim, doxycycline, clindamycin
Strep: penicillin
Risk factor for MRSA surgical SSTI infection
Prior MRSA infection
Nasal carrier MRSA
Recent hospitalization
Recent antibiotic admin
Gram neg/anaerobe coverage needed if surgical SSTI involve these areas
Axilla
GI tract
Perineum
Female GU tract
Use zosyn, carbapenem, or ceftriaxone + metronidazole
Animal bite treatment
First line: Augmentin
If immunocompromised, mod-severe injury, penetrated into joint, treat preemptively for 3-5 days
