Skin/Bone and Joint Infection

Skin/Bone and Joint Infection

1. Impetigo

   • -superficial infection of the skin -localized, purulent infection of the skin (begin as vesicles and become pustules) -children 2-5
   • Impetigo
   • Beta-hemolytic streptococci
   • Staph. Aureus
   • Treatment
     • Topicals
       • Mupirocin ointment TID (bacitracin and neomycin are less effective)
     • Oral
       • Dicloxacillin, Cephalexin, Erythromycin, Clindamycin- QID  Amoxicillin/clavulanate BID (25mg/kg/day of amox component ÷ BID)

2. Erysipelas

   • -upper dermis -lesions that are raised with a defininte demarcation between infected and non-infected -butterfly appearance
   • Cellulitis & Erysipelas
   • Beta-Hemolytic Strep
   • S. Aureus
   • Treatment
     • Oral
       • PCN PCN-resistant penicillins -1st gen chephalosporins( Cef---in) ex.Cefazolin, cephalexin

3. Cellulitis

   • -dermis + SQ tissue -Erythema -edema -pain -tenderness -malaise -advancing borders -fever, chills, tachycardia, hypotension -may have a portal of entry like trauma or impetigo
   • Risk factors
     • obesity edema trauma history of cellulits current leg ulcer
   • Rule out
     • acute dermatitis gout herpes zoster abscess septic arthritis osteomyelitis necrotising fascitis gas gangrene
   • Group A Strep
   • Staph. aureus (or MRSA)
     • CA-MRSA
       • Clindamycin bactrim +/- macrolides tetracyclines
     • MRSA
       • Vancomycin linezolid daptomycin ceftaroline -ORAL (doxycycline or minocycline, bactrim, linezolid)
       • take this for at least 5 days or until your symptoms resolve
   • Fresh water exposure
     • Aeromonas hydrophilia
   • Sea water exposure
     • vibrio vulnificus
   • Mild infection treatment
     • Oral -dicloxacillin -cephalexin -clindamycin -erythromycin
   • Severe cases(IV)
     • Nafcillin cefazolin clindamycin vancomycin
   • New Drugs
     • Tedozolid (MRSA or VRE), like linezolide Oritavacin single dose IV(expensive), like vanco or dapto Dalbavacin(MRSA or VRE), long terminal elimination half-life, expensive

4. Diabetic foot

   • Prevension
     • early detection optimize glycemic control foot inspections topical moisturezes well fitting shoes smoking cessation loose weight  smoke  peripheral neuropathy
   • Risk of amputation
     • ulceration structural foot deformity
   • Treatment of infected toot ulcers
     • Debridement antibiotics (broad spectrum)
     • Diabetic Foot Ulcers