30yo AAM skin popper with abscess and fever--

[Painter1]

30yo aam hx of skin-popping presents with fever and tennis ball sized cutaneous abscess over forearm. this is another topic where i can't seem to find solid recommendations from texts. read an article about how amp/sulbactam was a good option. read also in hedges that in someone with ivda, abscess, and fever u should treat for endocarditis prophylactally. aside from I&D. another source said clinda was appropriate. is there a standard regarding what antibotics are appropriate in this circumstance?

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[beyond all hope]

The patient is likely bacteremic from his abscess considering the fever. I don't know if I would assume that he has endocarditis unless he has a new murmur or other signs.

Note that up to 60% of abscesses these days are CA-MRSA. Clindamycin is a great choice because it covers that and gram positives. I don't think Unasyn covers CA-MRSA.

There are many different 'standards'. I use the Sanford antibiotic guide. Each hospital has a table with local bacterial resistance patterns, so you should keep that in mind when making antibiotic choices.

 

[Radiohead]

If the guy is gettng admitted, then I would hit 'em with IV Vanc, at least until cultures come back and then switch to appropriate PO. If the guy does not meet criteria for admission, then here we use alot of Bactrim for CA-MRSA. For sulfa allergy, surprisingly enough, Doxycycline kills 96% of our CA-MRSA, according to our most recent sensitivity report. I think Clinda was 77%. Some people like to add Keflex for strep coverage if there is a significant cellulitic component.

 

[EctopicFetus]

we have some bactrim resistance so we roll with clinda or doxy.. usually clinda

 

[mikecwru]

we have some bactrim resistance so we roll with clinda or doxy.. usually clinda

Our MRSA has some doxy and clinda resistance, so we start with bactrim for c-MRSA.

Note that if you do bactrim, you might not give enough coverage for run of the mill skin bugs, so you may want to do bactrim/keflex according to some sources.

mike

 

[Seaglass]

Does anyone have references for bactrim-keflex?

Don't forget that a lot of CA-MRSA has inducible clinda resistance.

The text books are going to be out of date on this one - CA-MRSA is a plague that is only 4-5 years old.