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Digital PharmD

Informatics in Pharmacy

Skin and Suture Infections

August 13, 2018 By Dr. G, PharmD

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Cellulitis:

  • Usually staph or strep
  • Treat for 5-10 days
  • PenG if confirmed Strep
  • cefazolin, cephalexin
  • ceftriaxone
  • clindamycin
  • Treat for MRSA if penetrating trauma, injectable drug use, purulent drainage, nasal colonization or other evidence of MRSA.
    • clindamycin, Bactrim or doxycycline with Beta-lactam.

Erysipelas:

  • Superficial dermis infection, usually on legs and feet.  Has a distinct raised border (look for that in questions)
  • Treat for 5 days with PenG or clindamycin

Necrotizing Fascitis:

  • Involved subcutaneous fat and superficial fascia.  Usuallly S. pyogenes (produces toxins), but can be MRSA, V. vulnificus (ocean water), A. hydrophilia (freshwater), Peptostreptococcus or other mixed anaerobes.
  • Treatment:
    • Debridement is necessary, antibiotics alone will not cure.
    • Empiric:
      • Vancomycin or linezolid or daptomycin (MRSA agents) plus 
      • pip/tazo or a carbapenem or ceftriaxone AND metronidazole or a fluoroquinolone AND metronidazole
    • If Group A strep or clostridia suspected, include clindamycin to suppress streptococcal toxin and cytokine production.
    • Confirmed Strep necrotizing fasciitis: High dose penicillin plus clindamycin

Filed Under: Infectious Disease

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia bcps Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020