An obese 64-year-old man with type 2 diabetes presents with redness and warmth of his lower left leg.
He noticed discomfort today and saw that his left lower leg had redness and was warm. He does not recall scratches or injury to his leg. He has not had fever or chills. He has no other symptoms. His diabetes has been well controlled with diet and metformin.
On exam, his blood pressure is 120/70, pulse is 80, temperature is 37 degrees Celsius.
In the left lower extremity, the patient had 1+ edema at the ankle, with a 14-cm x 20-cm warm, erythematous area just above the ankle and extending proximally.
His labs found an HCT of 44 and a WBC of 12,000. What do you recommend?
A. Vascular duplex exam
B. 1st generation cephalosporin
C. 1st generation cephalosporin + TMP/Sulfa
D. Oral clindamycin
E. IV vancomycin
This patient has cellulitisand should receive a beta lactam antibiotic, which will have the best coverage and lowest minimal inhibitory concentration for the likely organism, beta hemolytic streptococci. Clindamycin would likely work, but it has greater side effects. This patient does not need coverage for methicillin-resistant staphylococcus aureus (MRSA). I know many of you, if not most, know this, but I want to go through relevant data and formal recommendations, because of a recent call I received from a patient.
Erysipeloid
COMMENTARY
The Biggest Myth in Cellulitis Treatment
Douglas S. Paauw, MD
March 11, 2021
An obese 64-year-old man with type 2 diabetes presents with redness and warmth of his lower left leg.
He noticed discomfort today and saw that his left lower leg had redness and was warm. He does not recall scratches or injury to his leg. He has not had fever or chills. He has no other symptoms. His diabetes has been well controlled with diet and metformin.
On exam, his blood pressure is 120/70, pulse is 80, temperature is 37 degrees Celsius.
In the left lower extremity, the patient had 1+ edema at the ankle, with a 14-cm x 20-cm warm, erythematous area just above the ankle and extending proximally.
His labs found an HCT of 44 and a WBC of 12,000. What do you recommend?
A. Vascular duplex exam
B. 1st generation cephalosporin
C. 1st generation cephalosporin + TMP/Sulfa
D. Oral clindamycin
E. IV vancomycin
This patient has cellulitisand should receive a beta lactam antibiotic, which will have the best coverage and lowest minimal inhibitory concentration for the likely organism, beta hemolytic streptococci. Clindamycin would likely work, but it has greater side effects. This patient does not need coverage for methicillin-resistant staphylococcus aureus (MRSA). I know many of you, if not most, know this, but I want to go through relevant data and formal recommendations, because of a recent call I received from a patient.
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Cite this: The Biggest Myth in Cellulitis Treatment - Medscape - Mar 11, 2021.