SSTI Flashcards
(32 cards)
Treatment for impetigo?
Mupirocin BD
Treatment duration: 5 days
Oral Abx for impetigo and ecthyma?
No allergy:
Cephalexin 250-500mg QDS
Cloxacillin 250-500mg QDS
Allergy:
Clindamycin 300mg QDS
Duration: 7 days
Treatment for purulent SSTI?
Mainstay is I&D
Unless indication for adjunctive Abx:
- cannot drain completely
- lack of response to I & D
- extensive disease
- extremes of age
- immunosuppressed
- SIRS criteria
What are the 4 SIRS criteria
Temperature > 38
HR > 90
RR > 24
WBC > 12
What adjunctive abx therapy to use for purulent SSTI?
Organism is Staph Aureus
MSSA:
- PO Cloxacillin 250-500mg QDS
- PO Cephalexin 250-500mg QDS
MSSA, MRSA:
- Clindamycin PO 300mg QDS
- Cotrimoxazole 960mg BD
- Doxycycline
Duration:
Outpatient is 5-7 days
Inpatient is 7-14 days
Causative organisms for cellulitis and erysipelas?
Staph aureus
Beta hemolytic strep -> almost always causes erysipelas
If immunosuppression -> also at risk for Strep Pneumoniae, E. coli, Serratia, Pseudomonas
If chronic liver or renal disease -> also at risk for Vibrio, E. coli and pseudomonas
Criteria and organisms to cover for mild non purulent cellulitis/erysipelas?
No SIRS criteria
Strep
Treatment for mild non purulent cellulitis/erysipelas?
PO Penicillin VK 250-500mg QDS
Criteria and organisms to cover for moderate non purulent cellulitis / erysipelas?
> = 1 SIRS criteria
Strep plus minus staph
Treatment options for moderate non purulent cellulitis or erysipelas?
If only 1 SIRS criteria:
PO Penicillin VK 250-500mg QDS
PO Cloxacillin 250-500mg QDS (preferred because patient is sicker)
PO Cephalexin 250-500mg QDS (preferred because patient is sicker so cover for staph)
If 2 or more SIRS criteria,
IV Cefazolin 1-2g Q8H
Criteria and Organisms for severe non purulent cellulitis or erysipelas ?
> 2 SIRS criteria + hypotension/rapid progression/immunosuppression/comorbidities
Strep + Staph + gram negative (including pseudomonas)
Treatment for severe non purulent cellulitis or erysipelas?
IV Pip/Tazo 4.5g Q6-8H
IV Cefepime 2g Q8H
If there is MRSA risk factors:
add on IV vancomycin 15mg/kg Q8-12H
What are the 3 MRSA risk factors?
- Critically ill (admission to ICU)
- immunosupressed
- failure of abx without MRSA coverage
Criteria & Organisms for Mild Purulent cellulitis or erysipelas?
No SIRS criteria
Strep + Staph
Treatment for mild purulent cellulitis or erysipelas?
PO Cephalexin 250-500mg QDS
PO Cloxacillin 250-500mg QDS
If there are MRSA risk factors, use:
PO Clindamycin 300mg QDS
PO Co trimoxazole 960mg BD
Criteria and organisms for moderate purulent cellulitis or erysipelas?
1 or more SIRS criteria
Strep + Staph
Treatment for moderate purulent cellulitis or erysipelas?
Only 1 SIRS criteria:
PO Cephalexin 250-500mg QDS
PO Cloxacillin 250-500mg QDS
2 or more SIRS criteria:
IV Cefazolin 1-2g Q8H
IV Cloxacillin 1-2g Q4-6H
If there are MRSA risk factors, use:
IV Vancomycin 15mg/kg Q8-12H
Criteria and organisms for severe purulent cellulitis or erysipelas?
> 2 SIRS criteria + hypotension/rapid progression/immunosuppression/comorbidities
Strep + staph + gram neg including pseudomonas
Treatment for severe purulent cellultis or erysipelas?
IV Pip/tazo 4.5g Q6-8H
IV cefepime 2g Q8H
If risk factors for MRSA:
Add on IV vancomycin 15mg/kg Q8-12H
Organisms for cellulitis from bite wounds
- staph
- strep
- pasteurella multocida (animal bite)
- eikenella corrodens (human bite)
- oral anaerobes
Treatment for cellulitis from bite wound?
- Augmentin PO 625mg TDS
- Cefuroxime PO 250mg BD + Clindamycin PO 300mg QDS / Metronidazole PO 500mg TDS
- Ciprofloxacin/levofloxacin + Clindamycin / Metronidazole
Duration of treatment for cellulitis and erysipelas?
5 days
Pathophysiology of DFI?
Neuropathy
Vasculopathy
Immunopathy
Definition of Infection in DFI
Purulent discharge OR
2 or more signs of inflammation
- erythema
- warmth
- tenderness
- pain
- induration
