skin infections

Question 1

when is mastitis abx treatment indicated

Answer 1

if severe, systemically unwell, nipple fissure, symptoms do not improve after 12-24h of effective milk removal or if culture indicates infection

Question 2

can you still BF during treatment for mastitis

Answer 2

yes

Question 3

treatment of mastitis if abx indicated

Answer 3

fluclox 500mg QDS for 10-14 days
allergy: erythromycin 250-500mg QDS or clarith 500mg BD for 10-14 days

Question 4

treatment of localised non-bullous impetigo if not systemically unwell or high risk complications

Answer 4

hydrogen peroxide 1% cream 2-3 times a day for 5-7 days

Question 5

hydrogen peroxide cream for localised non bullous impetigo is unsuitable e.g.

Answer 5

around eyes - give topical abx

Question 6

treatment of widespread non bullous impetigo if pt is not systemically unwell or at high risk of complications

Answer 6

topical or oral abx
fusicid acid - resistance, then mupirocin
oral: 1st line fluclox, otherwise clarith or erythromycin

Question 7

Cellulitis and erysipelas are infections of the …….. tissues

Answer 7

SC

Question 8

Cellulitis and erysipelas are infections of the subcutaneous tissues, which usually result from …

Answer 8

contamination of a break in the skin.

Question 9

cellulitis and erysipelas
similarities and differences

Answer 9

Both conditions are characterised by acute localised inflammation and oedema. Lesions are more superficial in erysipelas and have a well-defined, raised margin.

Question 10

how would you treat non-bullous impetigo in pt who is systemically unwell or at high risk of complications, and all bullous impetigo

Answer 10

oral abx

1st line fluclox
otherwise clarith or erith

Question 11

is oral and topical abx treatment for impetigo ok

Answer 11

not recommended

Question 12

what would you do if patient under 1 years has bullous impetigo

Answer 12

refer, diffiuclt to treat

Question 13

would you say this is erysipelas or cellulitis and why

Answer 13

eysipelas

erysipelas and cellultiis look similar (both infections of the SC tissue with acute localised inflamation and oedema)

however, the lesions are more superficial (on the surface) and have a well defined, raised margin in erysipelas

Question 14

would you say this is erysipelas or cellulitis

Answer 14

cellulitis

in erysipelas, typically has a well defined raised margin

Question 15

what is 1st line for cellulitis or erysipelas

Answer 15

IV or oral depending on how bad it is

flucloxacillin 0.5–1 g 4 times a day for 5–7 days then review.

allergy: clarith, eryth (preg), oral doxy

Question 16

what is abx treatment for cellulitis or erysipelas near the eyes or nose

Answer 16

co amoxiclav 500/125 mg every 8 hours for 7 days then review.

allergy: clarith + metro

Question 17

patient has cellulitis on their face, near the nose. what abx would you give. no allergy to penicllin

Answer 17

co amoxiclav 625mg TDS for 7 days then review

needs to be this if near eyes or face

Question 18

patient has cellulitis on their face, near the nose. what abx would you give. they are allergic to penicllin

Answer 18

clarith 500mg BD + metro 400mg TDS for 7 days

Question 19

when may a trial of abx prophylaxis be considered for cellulitis or erysipelas

Answer 19

for pt who have been treated in hospital or under specialist advice for at least 2 separate episodes in the previous 12 months

review every 6 months

Question 20

where does a leg ulcer usually develop

Answer 20

lower leg between shin and ankle

Question 21

how long does a leg ulcer take to heal

Answer 21

more than 4-6 weeks

Question 22

true or false - leg ulcers are always infected

Answer 22

false
although most will be colonised with bacteria it doesnt mean that the wound is infected

Question 23

signs or symptoms of infected leg ulcer

Answer 23

redness
swelling beyond ulcer
localised warmth, tender
increased pain
fever

Question 24

what is this

Answer 24

leg ulcer

Question 25

underlying conditions which can cause leg ulcers e.g. (2) need to be managed to promote healing

Answer 25

oedema
venous insufficiency

Question 26

what is given for treatment of iNFECTED leg ulcer in pt who are non severely unwell

Answer 26

1st line fluclox 0.5-1g QDS 7 days

allergy: doxy, clarith, eryth

Question 27

patient has redness, itching, pain and swelling after an insect sting or bite, including bite from spiders and ticks.

does this indicate infection

Answer 27

usually localised inflammatory or allergic reaction esp when rapid onset

do not give abx unless signs of infection

Question 28

assess patients with a human or animal bite for …

Answer 28

risk of tetanus, rabies, blood borne viral infection (e.g. HIV, Hep B and C)

Question 29

what to do with wound after human or animal bite

Answer 29

clean and debride as necessary

Question 30

who would you offer oral abx prophylaxis to (human/animal bites)

Answer 30

• cat or human bite that has broken skin and drawn blood
• dog or other traditional pet bite that has broken skin and drawn blood IF penetrated bone, joint, tendon, vascular structure; visibly contaminated e.g. dirt or tooth; deep, puncture or crush wound or has caused significant tissue damage

Question 31

what would you give for prophylaxis after human, cat, dog or other traditional pet bite

1st line and alt, and pregnancy

Answer 31

CHILDREN OVER ONE MONTH AND ADULTS
- co amoxiclav 250/125 mg 3 times a day, alternatively 500/125 mg 3 times a day for 3 days.

alt 12-17: doxy + metro 3 days
under 12: co-trimoxazole for 3 days

pregnancy: seek specialist advice

Question 32

prophylaxis from human, cat, dog or other traditional pet - more severe, IV

Answer 32

co amoxiclav

alt: cefuroxime or ceftriaxone + metro

Question 33

for treatment of infected (human, cat, dog) bite children one month and over
plus alternatives

Answer 33

co amox 250/125 mg 3 times a day, alternatively 500/125 mg 3 times a day for 5–7 days.

alt

• For adults and young people aged 12 to 17 years, prescribe metronidazole plus doxycycline for 5 days.
• For children aged under 12 years, prescribe co-trimoxazole for 5 days.

Question 34

infected eczema treatment

Answer 34

topical 1st line: fusidic acid

if unsuitable or ineffective, oral abx

oral 1st line: fluclox
allergy: clairth or eryth(preg)