sanford guide page #?: outpatient cellulitis, covering for mrsa?

[bulldog]

For a simple case of small area of cellulitis, no fevers/chills, in a patient who presents to outpatient basis, what would u generally give? I looked for 'cellulitis' in sanford manual and came up w/ dicloxacillin, augmentin, azitromycin, etc.

however, i know that clinda and bactrim can be used for mrsa.

am i looking at wrong page?

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[beyond all hope]

Bactrim covers CA-MRSA well but not strep. Clinda covers both.

I usually give Keflex/Bactrim or Clinda for outpatient cellulitis. Note that Minocycline and Rifampin also cover CA-MRSA but I would never use either of them as solo drugs, especially Rifampin.

 

[NinerNiner999]

For evolving resistance it is always best to look at your local/regional sensitivities for MRSA and treat appropriately. Bactrim and Clinda are typically good drugs, but may not work at all in some locations (like East Baltimore)...

 

[EctopicFetus]

We usually use Clinda, rarely bactrim.

 

[Apollyon]

We usually use Clinda, rarely bactrim.

So how much bounce-back do you see, due to the $$ of clinda (and subsequent noncompliance)? Or do people truly use the Wal-Mart program (do you have it in AZ?)?

 

[EctopicFetus]

So how much bounce-back do you see, due to the $$ of clinda (and subsequent noncompliance)? Or do people truly use the Wal-Mart program (do you have it in AZ?)?

Walmart has their program out here but Clinda isnt covered and Bactrim is. Honestly, havent seen a lot of bounceback with Clinda but a decent bit with Bactrim. Using Clinda is what ID and our lab is recommending right now. IMO though some of our attendings over Rx this for simple Abscesses (without cellulitis). Overall the coverage has been good so far... We have some places where people can get Clinda for about $13 out of pocket.

While Az has the 2nd highest % of uninsured in the US ~20% our medicaid program AHCCS "Access" is really good and we have some pretty good social service support.

Now we have admitted people for real bad cellulitis / recurrent cellulitis but overall it is a real small percentage.

 

[Strength&Speed]

you gotta watch the "only small number of patients" readmitted for bad cellulitis or recurrent cellulitis. it only takes a few people out of a 100 to make for some awfully bad outcomes.