SSTI Cases Flashcards
A 25yo female presents with non-purulent bullous patches on her forearm. Her vitals are normal and she is otherwise a healthy lady. She is diagnosed with Impetigo. What is the best treatment for this patient? Include the route of administration, dose if necessary, as well as duration of treatment
Topical Mupirocin BD for 5 days
A 30yo male presented with purulent bullous patches on his trunks and calves. He is otherwise healthy. His vitals were normal, but the doctor decided to obtain a culture and initiate topical mupirocin BD.
3 days later, the culture is tested positive for MSSA. His vitals are still normal and his bullous patches have shrunk. What is the best course of action for his patient?
Continue topical mupirocin BD
WTF is a 16yo male patient presenting with ecthyma around his forearms and parts of his face.
SH: Avid soccer player, plays soccer at least 4 days a week regardless of rain or shine
TOB NIL, Alc NIL
Med Hx: NIL
Allergy: NKDA
Vitals: T 37.1ºC, RR 20, BP 117/77, HR 69
Dx: Ecthyma
Suggest treatment and counselling points for WTF
- PO Cephalexin 250-500 mg PO QDS for 7d OR
- PO Cloxacillin 250-500 mg PO QDS for 7d
Counselling points:
- Maintain hygiene: shower promptly after soccer to reduce sweat and moisture exposure
- Avoid sharing towels with teammates
- Appropriate counselling points for Abx
An otherwise healthy patient presents with Ecthyma. NKDA. The doctor suggests Clindamycin 300mg PO QDS for 3d to cover possible MRSA infection. Do you agree with the doctor? If not, suggest an appropriate therapy for this patient
Do not agree
- Patient does not have penicillin allergy
- MRSA coverage not required for empirical therapy
Suggestions:
- PO Cephalexin 250-500 mg PO QDS for 7d OR
- PO Cloxacillin 250-500 mg PO QDS for 7d
You are a senior-pharmacist in a clinic. A patient is diagnosed with Ecthyma. Your intern suggests to initiate PO Penicillin VK 500mg PO QDS as it is the narrowest spectrum of antibiotics. Do you agree with your intern? Why or why not? If you disagree, suggest the most appropriate treatment plan to initiate
Disagree
- In Ecthyma, possible organisms are Streps and MSSA
- Pen VK is too narrow spectrum and can only cover strep, hence may be insufficient in treating the patient
Suggestion:
- PO Cephalexin 250-500 mg PO QDS for 7d OR
- PO Cloxacillin 250-500 mg PO QDS for 7d
LOL is a 31yo male patient who presents to the clinic with inflammatory nodules
SH: Army officer, participates in many outfield training and camps
TOB 1 pack/3d, Alc 1 beer tower per weekend
Med Hx: GERD
Medications: PO antacid PRN
Allergy: NKDA
Vitals: T 37.0ºC, RR 19, BP 106/72, HR 60
Dx: Purulent SSTI
What is the best treatment for this patient, and what are relevant counselling points you would give?
Treatment: IandD
- Patient is otherwise healthy
- No indication for adjunctive Abx
Counselling points:
- Avoid sharing personal items
- Ensure personal hygiene: wash up after outfield
TMD is a 87yo female patient who presents at your clinic for a nodule with rim of erythematous swelling at her forearm
SH: Lives at home with her husband. Does housework and takes care of grandkids
Med Hx: HTN, DM
Medications: Enalapril 5mg BD, Metformin 850mg BD, Glipizide 10mg BD
Allergy: sulfa (hives)
Vitals: T 36.8ºC, RR18, BP 149/62, HR 72
Dx: Purulent SSTI
After successful I and D, the doctor asks your opinion about prescribing adjunctive systemic antibiotics. What is your advice?
Start adjunctive systemic antibiotics as she is 87yo (extremes of age is an indication)
Select PO since she has no signs of systemic illness: - PO Cephalexin 250-500 mg PO QDS - PO Cloxacillin 250-500 mg PO QDS Duration: Treat 5-7d (Outpatient) No need MRSA coverage
SLK is a 62yo male who is hospitalised for purulent SSTI due to signs of systemic illness. After I and D, he was started on IV Cefazolin 2g q8h, and his deep tissue culture was acquired.
2 days later, his vitals are:
T 39.2ºC, RR 25, BP 89/78, HR 83
The culture results are still unavailable, but the doctor is worried for this patient. The patient has sulfa allergy. What would you advice the doctor to do at this point?
Empiric therapy of IV cefazolin failed, which means coverage for MRSA should be considered
Consider switching to:
- IV vancomycin 15mg/kg q12h
- IV Clindamycin 600mg q8h
- Others: Doxycycline
- Duration: 7-14days (inpatient)
Once culture results are available, streamline or continue therapy as required.
MEOW is a 59yo patient who presents to the ambulatory care clinic for sharp erythema with raised border.
Allergy: NIL
Med Hx: CKD
Medications: Iron polymaltose, Sevelamer 1200mg TDS, Calcitriol 0.5mcg TDS
Vitals: T 38.4ºC, HR 70, RR 19, BP 105/80
Dx: Erysipelas
Suggest an empiric therapy for this patient
1 SIRS criteria: Moderate infection
Organisms to cover: Streps, maybe S.aureus
Recommendation:
PO
Cephalexin/Cloxacillin 250-500mg QDS
Duration: at least 5 days
A 28yo female patient presents with purulent cellulitis.
Her vitals are: T 38.2ºC, HR70, RR19, BP 117/76
She has NKDA
She is otherwise a healthy patient
The doctor suggested to use PO penicillin VK 250mg QDS for 5 days. Do you agree with him? Why or why not? Suggest an appropriate therapy for this patient
Disagree
- Causative organism for purulent cellulitis: Streps and S.aureus
- Pen VK cannot cover S.aureus
Suggestion:
- PO Cephalexin 250-500 mg PO QDS
- PO Cloxacillin 250-500 mg PO QDS
Treat at least 5 days
TY is a 76yo male patient who presents to the emergency department for purulent patches on his upper extremities. He recently undergone a liver transplant (3 months ago).
Vitals: T 39.2ºC, HR70, RR17, WBC 18 x 10^9/L, BP 102/70
Allergies: NKDA
Dx: Purulent Cellulitis
Both his blood and cutaneous aspirates have been sent for culture. Meanwhile, what empirical treatment will you suggest for this patient?
Suggestion: IV Vancomycin 15mg/kg q8h, until culture results are available (to cover Streps, S.aureus and possible MRSA)
Patient has 2 SIRS criteria (WBC and Temp), hence moderate purulent cellulitis. Hence organisms to cover are Streps and S.aureus.
Since he undergone a liver transplant, he is most likely immunosuppressed due to the drugs he must take for the transplant, hence this is an MRSA risk factor. Thus, MRSA coverage must be considered
MNM is a 67yo male patient who presents to the emergency department for purulent patches on his upper extremities. He is currently on chemotherapy.
Vitals: T 39.2ºC, HR70, RR25, WBC 18 x 10^9/L, BP 86/49
Allergies: NKDA
Dx: Purulent Cellulitis
Both his blood and cutaneous aspirates have been sent for culture. Meanwhile, what empirical treatment will you suggest for this patient? Also, suggest the total duration of treatment which includes both empirical and culture-directed therapy.
> 2 SIRS criteria with immunosuppression
- Severe infection with MRSA risk factor
Suggested treatment:
- IV Pip/tazo 4.5g q8h AND
- IV Vancomycin 15mg/kg q8h
Duration: 7-14 days (due to immunosuppressed)
KKK is a 32yo patient who presents with a purulent bite wound. He is otherwise healthy
Dx: Cellulitis from bite wound
Vitals: T 37.3ºC, HR 72, RR 18, BP 110/81
Allergies: Penicillin (severe rash)
Suggest Abx choices, including the duration of treament
Abx:
- PO Cipro 500mg BD/ PO Levofloxacin 750mg BD
AND
- PO Clindamycin 300mg QDS/PO Metronidazole 500mg TDS
Duration of treatment: at least 5 days
Jiao Tong is a 71yo female patient who presents to you with ulcer at her big toe. She is concerned about the ulcer as she suspect it is an infection Upon physical examination, her ulcer is non-purulent and non-erythematous. The ulcer feels warm and soft. She does not feel pain from her toe
Med Hx: Diabetes, HTN
Medications: Insulin NPH 12u BD, Valsartan 160mg BD
Allergies: NKDA
Vitals: T 37.0ºC, HR 68, RR 19, BP 129/76
Suggest the most appropriate therapy for her condition.
No need to treat: Ulcer is not indicative of an infection. However, close monitoring may be required, and proper hygiene should be observed
LP is a 65yo male patient who presents with an ulcer on the ball of her feet. Upon physical examination, the ulcer is purulent with a 1.8cm erythema surrounding the ulcer.
Dx: Diabetic Foot infection, no bone involvement
Med Hx: Diabetes, HTN, Dyslipidemia
Medications: Metformin 850mg TDS, Glipizide 10mg BD, Enalapril 5mg BD, Atorvastatin 10mg OD
Allergies: NKDA
Vitals: T 36.1ºC, HR65, RR20, BP 121/76
Suggest the most appropriate therapy for her condition
- Erythema < 2cm with no SIRS criteria, hence mild foot infection
- No need MRSA coverage since patient has no MRSA risk factor
Treatment Options:
- PO Cephalexin 250-500mg QDS
- PO Cloxacillin 250-500mg QDS
Duration of treatment: 1-2 weeks (mild with no bone involvement)
