Cellulitis medical therapy: Difference between revisions
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Most common causative pathogen is [[Staphylococcus aureus]] ,a gram positive bacteria. This is empirically treated with Beta-lactum antibiotics. | Most common causative pathogen is [[Staphylococcus aureus]] ,a gram positive bacteria. This is empirically treated with Beta-lactum antibiotics. Latest reports suggest that this bacterium has acquired resistance(MRSA) and newer drugs are to be used.Reports from the laboratory regarding sensitivity of the pathogen is key factor in deciding the therapy. | ||
Revision as of 05:32, 19 June 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aditya Govindvarjhulla, M.B.B.S.
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Cellulitis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Cellulitis medical therapy On the Web |
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American Roentgen Ray Society Images of Cellulitis medical therapy |
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Risk calculators and risk factors for Cellulitis medical therapy |
Overview
Antibiotics - typically a combination of intravenous and oral antibiotics are administered. Bed rest and elevation of affected limbs is also recommended. In patients with edema of extremities which is a risk factor again, in such cases compressive stockings may really aid in our treatment. For abscess which are small and unaffecting the surrounding tissue can be treated with simple incision and drainage. Drink plenty of fluids as well - at least 8 glasses of water a day.
Medical Therapy
Antibiotics are the mainstay of treatment of medical therapy. Primary aim of the physician for using antibiotics is to
- Treatment of the infection.
- Prevent complications.
- Reduce hospital stay or morbidity.
Choice of antibiotic therapy depends on few factors.
- Age of the individual
- Co-morbid conditions
- Site of lesion
- Severity of lesion
- Pathogen involved(gram positive or negative/aerobic or anaerobic)
- Strain and resistance of the pathogen
Most common causative pathogen is Staphylococcus aureus ,a gram positive bacteria. This is empirically treated with Beta-lactum antibiotics. Latest reports suggest that this bacterium has acquired resistance(MRSA) and newer drugs are to be used.Reports from the laboratory regarding sensitivity of the pathogen is key factor in deciding the therapy.
Uncomplicated Cellulitis
- In cases of simple infection without abscess or draining Dicloxacillin, Amoxacillin or first generation cephalosporins like Cephalexin are used.
- Patients allergic to penicillin drugs can be administered with macrolide antibiotics like azithromycin.
- A notion of giving a parenteral shot of antibiotic and then oral medication to cover the lag period of oral one.
Severe Cellulitis
- In severe cases parenteral therapy is advocated.
- Higher generation of cephalosporins like Ceftrioxone,Cefuroxime are used.
- Penicillin allergic individuals can be given Vancomycin / Clindamycin.
- In diabetic individuals broad coverage antibiotics are used. Diabetics are prone to infections to empiric therapy include drugs covering gram positive/negative & anaerobic bacteria. Carbapenams, Betalactum antibiotics with Betalactamase inhibitors are given in a combined regimen for antibiotic coverage.
Special Cases
- MRSA- Methicillin resistant Staphylococcus Aureus
- Bite Wounds
- They are often polymicrobial and anaerobic in nature.[3]
- Mild cases can be treated with Amoxicillin/Clavulanate , in case of penicillin allergy cotrimoxazole along with Metronidazole is used.
- In severe cases Piperacillin/Tazobactum are used.
- Acquatic punctures/lacerations
- This is seen mainly in professional swimmers and divers both in freshwater and in brackish water.
- Failure to recognize these wounds and delay in treatment may cause a larger morbidity.
References
- ↑ Moran GJ, Krishnadasan A, Gorwitz RJ; et al. (2006). "Methicillin-resistant S. aureus infections among patients in the emergency department". N. Engl. J. Med. 355 (7): 666–74. doi:10.1056/NEJMoa055356. PMID 16914702. Unknown parameter
|month=ignored (help) - ↑ Stryjewski ME, Chambers HF (2008). "Skin and soft-tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus". Clin. Infect. Dis. 46 Suppl 5: S368–77. doi:10.1086/533593. PMID 18462092. Unknown parameter
|month=ignored (help) - ↑ Abrahamian FM, Goldstein EJ (2011). "Microbiology of animal bite wound infections". Clin. Microbiol. Rev. 24 (2): 231–46. doi:10.1128/CMR.00041-10. PMC 3122494. PMID 21482724. Unknown parameter
|month=ignored (help)