Empiric treatment for Infection in Soft Tissue

Question

Noah is a 60 years old male with diabetes, hypertension, epilepsy, and HIV.

He presents to the emergency department for the second time after failing

his oral antibiotic treatment with Cephalexin. His current chief complaint is

having pain on his arm. He indicates that he is having fever, chills and SOB.

On examination, the area of the arm is red with edema and lesions have

poorly defined margins. While obtaining his medical history. Noah accepts

to be an IV drug abuser. Noah’s vital signs are the following: T: 100.4 F,

HR: 110 bpm, RR: 30 breath/min and BP 140/92 mmHg. According to his

CBC, he has leukocytosis (WBC: 18,000 cells/mL). What is the appropriate

empiric treatment to manage his infection (select ALL that apply)?

A. Bactrim DS PO BID for 7 days

B. Cefazolin 1 g IV q8h for 5 days

C. Piperacillin/tazobactam 3.375 g IV q8h for 7-14 days

D. Imipenem/cilastatin 1 g IV q6h for 7-14 days

E. Vancomycin 15 mg/kg IV q12h for 7-14 days

Answer 1

The patient has classic symptoms of possible underling sepsis ie. fever, chills, SOB, and elevated WBC. The treatment of Cephalexin (cephalsoipirin) can be used as treatment for his infection. However, this sounds like a drug resistant cellulitis. Cellulitis have undefined borders, redness, edema of the tissue and pain. The most underlining cause in an IV drug user is Staphylococcus aureus. Due to his septic symptoms and drug resistance, I would assume it is MRSA Methicilin Resistant Staphylococcus aureus a s the culprit. Vancomycin is a good medication to escalate treatment. (B) is the same medication as Cephalexin and it won't do anything.

The best answer is Vancomycin (E).