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| ==Medical Therapy==
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| * For patients with purulent [[cellulitis]], cultures are recommended and empirical therapy for Community Associated-MRSA (CA-MRSA) should be started.
| | ! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Tuberculin Rection}} |
| * For patients with non-purulent [[cellulitis]], empirical therapy for [[β-hemolytic streptococci]] should be started.
| | ! style="background: #4479BA; width: 450px;" | {{fontcolor|#FFF|Considered a Positive Result in:}} |
| * The duration of the therapy should be individualized for the clinical response of each patient; 5-10 days is usually recommended.
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| * The treatment of [[cellulitis]] in neonates usually requires hospitalization and parenteral therapy. Oral therapy is given for completion of the treatment when the pathogen is unknown.
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| * Optimal dose should be based on determination of serum concentrations.
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| * Patients with renal insufficiency may require dose adjustment in case of [[cephalosporins]].
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| * [[Clindamycin]] is an alternate therapy for patients at risk of severe hypersensitivity reaction to [[penicillins]] and [[cephalosporins]].
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| * [[Doxycycline]] is '''NOT''' recommended for children <8 years of age.
| |
| * Studies have shown an increase in treatment failure with [[TMP-SMX]] compared to other agents for [[cellulitis]] in children, reflecting [[TMP-SMX]] less action against [[Group A streptococcus]].<ref name="pmid19470525">{{cite journal| author=Elliott DJ, Zaoutis TE, Troxel AB, Loh A, Keren R| title=Empiric antimicrobial therapy for pediatric skin and soft-tissue infections in the era of methicillin-resistant Staphylococcus aureus. | journal=Pediatrics | year= 2009 | volume= 123 | issue= 6 | pages= e959-66 | pmid=19470525 | doi=10.1542/peds.2008-2428 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19470525 }} </ref>
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| ==Therapy based on Anatomical Location<SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from </SMALL></SMALL></SMALL></SMALL></SMALL>==
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| <SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
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| {|
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| <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #A1BCDD; text-align: center;">
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| <font color="#FFF">
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| '''Location'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table12" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Buccal'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table13" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Periorbital'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table14" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Orbital'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table15" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Perianal'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table16" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ ''''''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table17" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ ''''''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table18" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ ''''''
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| </font>
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| </div>
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| | |
| | valign=top | | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table12" style="background: #FFFFFF;" | |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Buccal Cellulitis}} | |
| |- | | |- |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | | | style="padding: 5px 5px; background: #DCDCDC;" | '''≥ 5 mm ''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | |
| | *HIV-positive person |
| | *Recent contacts of TB case |
| | *Persons with nodular or fibrotic changes on CXR consistent with old healed TB |
| | *Patients with organ transplants and other immunosuppressed patients |
| |- | | |- |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[''''' <br> OR <br> ▸ '''''[[''''' | | | style="padding: 5px 5px; background: #DCDCDC;" | '''≥ 10 mm ''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | |
| | *Recent arrivals (less than 5 years) from high-prevalent countries |
| | *Injection drug users |
| | *Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes, hospitals, homeless shelters, etc.) |
| | *Mycobacteriology lab personnel |
| | *Persons with clinical conditions that place them at high risk (e.g., diabetes, prolonged corticosteroid therapy, leukemia, end-stage renal disease, chronic malabsorption syndromes, low body weight, etc) |
| | *Children less than 4 years of age, or children and adolescents exposed to adults in high-risk categories |
| |- | | |- |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | | | style="padding: 5px 5px; background: #DCDCDC;" | '''≥ 15 mm ''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | |
| | *Persons with no known risk factors for TB |
| |- | | |- |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[''''' <br> OR <br> ▸ '''''[['''''
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| |} | | |} |
| |}
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|
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table13" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Periorbital Cellulitis}}
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[''''' <br> OR <br> ▸ '''''[['''''
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[''''' <br> OR <br> ▸ '''''[['''''
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| |}
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| |}
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|
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table14" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Orbital Cellulitis}}
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[''''' <br> OR <br> ▸ '''''[['''''
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[''''' <br> OR <br> ▸ '''''[['''''
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| |}
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| |}
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|
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table15" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Perianal Cellulitis}}
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[''''' <br> OR <br> ▸ '''''[['''''
| |
| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[''''' <br> OR <br> ▸ '''''[['''''
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| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table16" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|## Cellulitis}}
| |
| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[''''' <br> OR <br> ▸ '''''[['''''
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[''''' <br> OR <br> ▸ '''''[['''''
| |
| |}
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| |}
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| |}
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|
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| ==Special Considerations<SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from </SMALL></SMALL></SMALL></SMALL></SMALL>==
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|
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| For the following conditions, an additional antibiotic therapy should be added to the usual regimen in order to cover specific pathogens associated to those circumstances.
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|
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| <SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
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|
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| {|
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| | valign=top |
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| <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #A1BCDD; text-align: center;">
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| <font color="#FFF">
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| '''Special Considerations'''
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| </font>
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| </div>
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|
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| <div class="mw-customtoggle-table19" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Diabetic Foot Ulcer'''
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| </font>
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| </div>
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|
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| <div class="mw-customtoggle-table20" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Neutropenic Patients'''
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| </font>
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| </div>
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|
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| <div class="mw-customtoggle-table22" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Sal Water Wound Exposure'''
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| </font>
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| </div>
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|
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| <div class="mw-customtoggle-table23" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Fresh Water Wound Exposure'''
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| </font>
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| </div>
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|
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| <div class="mw-customtoggle-table24" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Butcher, Fisherman, Veterinarian'''
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| </font>
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| </div>
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table19" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Diabetic Foot Ulcer}}
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[ '''''
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[ <br> OR <br> ▸ '''''[['''''
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| |-
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| |}
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| |}
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|
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table20" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Neutropenic Patients}}
| |
| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center |
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| |}
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| |}
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|
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table22" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Salt Water Wound Exposure <br> ''(Vibrio vulnificus)''}}
| |
| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 200 mg IV initial dose, then 50-100 mg IV q12h'''''
| |
| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]]''''' <br> OR <br> ▸ '''''[[Ciprofloxacin]]'''''
| |
| |}
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| |}
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|
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table23" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Fresh Water Wound Exposure <br> ''(Aeromonas spp)''}}
| |
| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ciprofloxacin]] 400mg IV q12h''''' <br> OR <br> ▸ '''''[[Ceftazidime]]''''' <BR> PLUS <BR>
| |
| ▸ '''''[[Gentamicin]]'''''
| |
| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Meropenem]]''''' <br> OR <br> ▸ '''''[[Imipenem]]-cilastatin'''''
| |
| |}
| |
| |}
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table24" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Butcher, Fisherman, Veterinarian <br> ''(Erysipelothrix rhusiopathiae)''}}
| |
| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin]] 500 mg PO q8hr'''''
| |
| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ciprofloxacin]]''''' <br> OR <br> ▸ '''''[[Cefotaxime]]''''' <br> OR <br> ▸ '''''[[Imipenem]]-cilastatin'''''
| |
| |}
| |
| |}
| |
| |}
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|
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| ==References==
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|
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| {{Reflist|2}}
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