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Non-pharmacologic

Non-pharmacologic. Elevate the affected area to facilitate gravity drainage of edema and inflammatory substances Patients with edema may benefit from treatment with compressive stockings and diuretic therapy Treat underlying conditions

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Non-pharmacologic

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  1. Non-pharmacologic • Elevate the affected area to facilitate gravity drainage of edema and inflammatory substances • Patients with edema may benefit from treatment with compressive stockings and diuretic therapy • Treat underlying conditions • Tineapedis, lymphedema, and chronic venous insufficiency

  2. Pharmacologic • Empiric antibiotic therapy should include activity against beta-hemolytic streptococci and S. aureus • Empiric therapy for MRSA should be initiated for patients with recurrent infection in the setting of underlying predisposing conditions, patients with a previous episode of proven MRSA infection, and patients with systemic toxicity

  3. Pharmacologic • Patients presenting with an initial episode, in the absence of significant comorbidities, should be treated with agents that have activity against beta-hemolytic streptococci and methicillin-susceptible S. aureus • Patients with mild cellulitis can be treated with oral antibiotics • Patients with signs of systemic toxicity or erythema that has progressed rapidly should be treated initially with parenteral antibiotics • Patients with recurrent infection in the setting of underlying predisposing conditions or with a previous episode of proven MRSA infection should receive empiric coverage for beta-hemolytic streptococci and MRSA

  4. Pharmacologic • Fluoroquinolones have been approved for the treatment of uncomplicated cellulitis but are not adequate for treatment of MRSA infections

  5. Medications given to the patient • Clindamycin 100mg/SIVP every 6 hours • Amikacin 165mg/SIVP once a day every 24 hours • Paracetamol 120mg/5ml, 5ml every 6 hours as needed for pain and fever

  6. Cellulitis • Common pathogens • S. aureus, Group A streptococcus • Drugs of first choice • Penicillinase-resistant cephalosporin (third-gen) • Alternative • Vancomycin, clindamycin, linezolid

  7. Clindamycin (p. 751) • Inhibits protein synthesis by interfering with the formation of initiation complexes and with aminoacyl translocation reactions • Binds to the 50S subunit bacterial ribosome • Inhibits streptococci, staphylococci, and pneumococci • Bacteroides sp. And other anaerobes are usually susceptible • Enterococci and gram-negative aerobes are resistant

  8. Clindamycin • 90% protein bound • Penetrates well into most tissues, except brain and cerebrospinal fluid • Penetrates well into abscesses and is actively taken up and concentrated by phagocytic cells • Metabolized in the liver, and both active drug and active metabolites are excreted in bile and urine • Half life: 2.5hours; 6hours in anuric patients • No dosage adjustment needed for renal failure

  9. Clindamycin • Adverse effects • Diarrhea, nausea, skin rashes • Impaired liver function • Neutropenia

  10. Amikacin (p. 760, 776) • Inhibits gram-negative enteric bacteria including proteus, pseudomonas, enterobacter, and serratia • Nephrotoxic and ototoxic

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