Infectious Disease Committee - Part 2

Question 1

Empiric oral or IV antibiotics must be started on a pediatric patient with an abscess if: (3 answers)

Answer 1

1. Child less than 3 months of age
2. Significant associated cellulitis
3. Fever or systemic signs of illness

Question 2

For an uncomplicated skin abscess that you would want to treat with antibiotics post-drainage, what antibiotic is recommended?

Answer 2

TMP/SMX - covers 100% of MSSA and CA-MRSA and is generally well tolerated

Question 3

What is one limitation of using TMP/SMX for skin abscesses in regards to pathogen coverage?

Answer 3

Poor coverage for Group A Strep (but this is a rare cause of skin abscesses)

Question 4

In the setting of an abscess with significant cellulitis where you want to cover for Group A Strep, MSSA, and MRSA; what antibiotics is appropriate for outpatients?

Answer 4

TMP/SMX with a second antibiotic (typically cephalexin) pending cultures

Question 5

Do we recommend decolonization treatments for MRSA in patients?

Answer 5

No. Decolonization is usually not advised because failure is common even with multiple interventions involving the child and family members

Question 6

What is the duration of antibiotic use if a patient requires it for abscess management?

Answer 6

Antibiotics are usually given for a 7 day course

Question 7

When does the acquisition of chicken pox occur?

Answer 7

Occurs from patient contact 24 hours and possibly up to 96 hours before the development of the rash

Question 8

When should a child with chickenpox be able to return to school or daycare?

Answer 8

Can return as soon as he or she is well enough to participate normally in all activities, regardless of the state of the rash

Question 9

What are the two maternal medications written in the CPS statement where breastfeeding needs to be discontinued?

Answer 9

High-dose metronidazole - Discontinue breastfeeding for 12 h to 24 h to allow excretion of dose
Primaquine or Quinine (antiparasitic) - Contraindicated during breastfeeding unless both mother and baby have normal G6PD levels

Question 10

Evidence suggests that biologics can increase your risk in what type of infections compared to standard immunosuppressive therapy?

Answer 10

1. TB

2. Fungal infections

Question 11

When should inactivated vaccines be administered before starting a biologic?

Answer 11

14 or more days before

if on high dose steroids, at least 1 month before

Question 12

When should live vaccines be administered before starting a biologic?

Answer 12

If possible, at least 1 month before

Question 13

What does the MMR vaccine do to your TST?

Answer 13

Do not do your TST until 4-6 weeks after MMR immunization because the vaccine can temporarily suppress TST activity