skin infections Flashcards
when is mastitis abx treatment indicated
if severe, systemically unwell, nipple fissure, symptoms do not improve after 12-24h of effective milk removal or if culture indicates infection
can you still BF during treatment for mastitis
yes
treatment of mastitis if abx indicated
fluclox 500mg QDS for 10-14 days
allergy: erythromycin 250-500mg QDS or clarith 500mg BD for 10-14 days
treatment of localised non-bullous impetigo if not systemically unwell or high risk complications
hydrogen peroxide 1% cream 2-3 times a day for 5-7 days
hydrogen peroxide cream for localised non bullous impetigo is unsuitable e.g.
around eyes - give topical abx
treatment of widespread non bullous impetigo if pt is not systemically unwell or at high risk of complications
topical or oral abx
fusicid acid - resistance, then mupirocin
oral: 1st line fluclox, otherwise clarith or erythromycin
Cellulitis and erysipelas are infections of the …….. tissues
SC
Cellulitis and erysipelas are infections of the subcutaneous tissues, which usually result from …
contamination of a break in the skin.
cellulitis and erysipelas
similarities and differences
Both conditions are characterised by acute localised inflammation and oedema. Lesions are more superficial in erysipelas and have a well-defined, raised margin.
how would you treat non-bullous impetigo in pt who is systemically unwell or at high risk of complications, and all bullous impetigo
oral abx
1st line fluclox
otherwise clarith or erith
is oral and topical abx treatment for impetigo ok
not recommended
what would you do if patient under 1 years has bullous impetigo
refer, diffiuclt to treat
would you say this is erysipelas or cellulitis and why
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
would you say this is erysipelas or cellulitis
cellulitis
in erysipelas, typically has a well defined raised margin
what is 1st line for cellulitis or erysipelas
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
what is abx treatment for cellulitis or erysipelas near the eyes or nose
co amoxiclav 500/125 mg every 8 hours for 7 days then review.
allergy: clarith + metro
patient has cellulitis on their face, near the nose. what abx would you give. no allergy to penicllin
co amoxiclav 625mg TDS for 7 days then review
needs to be this if near eyes or face
patient has cellulitis on their face, near the nose. what abx would you give. they are allergic to penicllin
clarith 500mg BD + metro 400mg TDS for 7 days
when may a trial of abx prophylaxis be considered for cellulitis or erysipelas
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
where does a leg ulcer usually develop
lower leg between shin and ankle
how long does a leg ulcer take to heal
more than 4-6 weeks
true or false - leg ulcers are always infected
false
although most will be colonised with bacteria it doesnt mean that the wound is infected
signs or symptoms of infected leg ulcer
redness
swelling beyond ulcer
localised warmth, tender
increased pain
fever
what is this
leg ulcer
underlying conditions which can cause leg ulcers e.g. (2) need to be managed to promote healing
oedema
venous insufficiency
what is given for treatment of iNFECTED leg ulcer in pt who are non severely unwell
1st line fluclox 0.5-1g QDS 7 days
allergy: doxy, clarith, eryth
patient has redness, itching, pain and swelling after an insect sting or bite, including bite from spiders and ticks.
does this indicate infection
usually localised inflammatory or allergic reaction esp when rapid onset
do not give abx unless signs of infection
assess patients with a human or animal bite for …
risk of tetanus, rabies, blood borne viral infection (e.g. HIV, Hep B and C)
what to do with wound after human or animal bite
clean and debride as necessary
who would you offer oral abx prophylaxis to (human/animal bites)
- 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
what would you give for prophylaxis after human, cat, dog or other traditional pet bite
1st line and alt, and pregnancy
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
prophylaxis from human, cat, dog or other traditional pet - more severe, IV
co amoxiclav
alt: cefuroxime or ceftriaxone + metro
for treatment of infected (human, cat, dog) bite children one month and over
plus alternatives
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.
infected eczema treatment
topical 1st line: fusidic acid
if unsuitable or ineffective, oral abx
oral 1st line: fluclox
allergy: clairth or eryth(preg)
