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

Discussion in 'General Residency Issues' started by bulldog, Feb 19, 2007.

  1. bulldog

    bulldog Senior Member
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    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?
     
  2. beyond all hope

    beyond all hope Senior Member
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    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.
     
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  3. NinerNiner999

    NinerNiner999 Senior Member
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    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)...
     
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  4. EctopicFetus

    EctopicFetus Keeping it funky enough
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    We usually use Clinda, rarely bactrim.
     
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  5. Apollyon

    Apollyon Screw the GST
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    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?)?
     
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  6. EctopicFetus

    EctopicFetus Keeping it funky enough
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    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.
     
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  7. Strength&Speed

    Strength&Speed Need more speed......
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    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.
     
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