Dermatology - Bacteria

Question 1

Impetigo

Answer 1

dicloxacillin 250-500 mg po 4-6 hr x 5-10 d
topical mupirocin tid 5-10d
wash lesion 2-3x d or warm soak

Question 2

Cellulitis penicillin allergic

Answer 2

cephalexin 500 mg po qh6
clindamycin 450mg po qh6
cefazolin 1mg iv q8h

Question 3

Cellulitis

Answer 3

mild mod - dicloxacillin 500 mg po q6h

severe - nafcillin 1-2g IV q4h or vancomycin 1 g iv q12h

Question 4

Erysipelas

Answer 4

mild-mod penicillin V 500 mg po q6h

severe - pen G 1-2 million U q6h

Question 5

Erysipelas pen allergy

Answer 5

Cephalexin 500mg po q6h
Erythromycin 500mg po q6h Clindamycin 450mg po q6 Cefazolin 1g iv q8h
Clindamycin 900mg iv q8h

Question 6

Pen allergy

Answer 6

azithromycin or erythromycin

Question 7

Infectious Folliculitis

Answer 7

Bactroban topical, dicloxacillin or cephalosporin first choice

Question 8

Infectious Folliculitis due to MRSA

Answer 8

clindamycin, TMP/SMX

Question 9

Pseudofolliculitis barbae

Answer 9

skin cleansers, bacitracin, bactroban, erythro, diclox

Question 10

Pseudomonas aeruginosa folliculitis

Answer 10

self limiting

Question 11

Skin abscess abx - only in immunocomp, DM, or systemic features

Answer 11

Dicloxacillin 250-500mg po q4-6h x 7-10d, erythromycin, cephalexin 500-1000 mg po qid 7-10d

Question 12

Cutaneous abscess inpatient

Answer 12

Vancomycin 15 mg/kg IV q12h or
Clindamycin 600 mg PO or IV q8h
Surgical I&D with washout
Obtain cultures to direct inpatient therapy

Question 13

Cutaneous abscess outpatient

Answer 13

Clindamycin 300-450 mg PO q8h for 5-7d or
Cephalexin 250-500 mg PO q6h for 5-7d or
Dicloxacillin 250-500 mg PO q6h for 5-7d or
Trimethoprim-sulfamethoxazole DS 1-2 tablets PO q12h for 5-7d

Question 14

Necrotizing Fasciitis

Answer 14

Surgical debridement first
metronidazole+clindamycin+ceftriaxone
vancomycin+ piperacillin tazobactam/imipenem/meropenem/clinda
Ampicilin sulbactam + clinda + cipro
antibiotics for a minimum of 3 wks

Question 15

Myonecrosis (Gas gangrene)

Answer 15

IV vanco + zosyn/meropenem/clinda

surgical debridement of infected muscles

Question 16

Ecthyma Gangrenosum

Answer 16

antipseudomonal penicillin (piperacillin) should be used in conjunction with an aminoglycoside (gentamicin)
fluoroquinolones, third-generation cephalosporins, or aztreonam also effective