Test your remedy knowledge with the MKSAP challenge, in union with the American College of Physicians.
A 25-year-decayed woman is evaluated for redness that developed throughout her right leg at the site of a mosquito bite. She is otherwise healthy and takes no medications.
On material examination, temperature is 37.2 °C (99.0 °F), descendants pressure is 120/70 mm Hg, beating rate is 70/min, and respiration rate is 14/min. There is every erythematous 3 × 3-cm patch on the right thigh. The sunken space adjoining the basement is warm to the touch with no evidence of purulence, fluctuance, crepitus, or lymphadenopathy.
Which of the following is the ut~ appropriate empiric outpatient therapy?
MKSAP Answer and Critique
The amend answer is A: Cephalexin.
This uncomplaining has nonpurulent cellulitis that is greatest in number likely caused by β-hemolytic streptococci, and experimental outpatient treatment with a β-lactam cause such as cephalexin or dicloxacillin is recommended. Cellulitis is a bacterial pelt infection involving the dermis and subcutaneous tissues. This bane is most frequently associated with dermatologic stipulations involving breaks in the skin, similar as eczema, tinea pedis, or chronic skin ulcers, and conditions leading to chronic lymphedema, such as mastectomy and lymph excrescence dissections or saphenous vein grafts used in bypass surgery. Cellulitis should subsist suspected in patients with the distressing onset of spreading erythema, edema, trouble or tenderness, and warmth. Fever, for all that common, is not uniformly present. Patients by severe disease may have associated systemic toxicity. The principally common pathogens are Staphylococcus aureus and the β-hemolytic streptococci, especially assign places to A β-hemolytic streptococci (GABHS). GABHS is most often associated with nonpurulent cellulitis, while on the contrary S. aureus may cause concomitant abscesses, furuncles, carbuncles, and bullous impetigo.
Doxycycline and trimethoprim-sulfamethoxazole be under the necessity activity against community-associated methicillin-resistant S. aureus however are not reliably effective against β-hemolytic streptococci.
Fluconazole is each antifungal agent. Fungi do not usually account cellulitis in young, healthy persons, end fungal infection should be considered in immunocompromised patients.
Metronidazole is ~y antimicrobial agent used to treat some anaerobic bacterial and protozoal infections. Although metronidazole is assiduous against some microaerophilic bacteria, it is not efficient for treatment of β-hemolytic streptococci.
Outpatients by nonpurulent cellulitis should be treated empirically by a β-lactam agent such in the same manner with cephalexin or dicloxacillin that is nimble against β-hemolytic streptococci.
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