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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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sábado, 23 de julio de 2016

Celulitis Antibiotic Selection

emDocs - July 22, 2016 - Authors: Bucher J and Cuthbert D 
Edited by: Koyfman A and Long B
"Introduction
The treatment of cellulitis has changed tremendously in the last ten years. With the development of community-acquired MRSA infections along with an increasing number of immunocompromised hosts, there is concern about missing MRSA if not treating cellulitis for it. However, the Infectious Disease Society of America (IDSA) released their skin and soft tissue guidelines in 2014, providing clear instructions for both antibiotic choice and who should be treated for suspected MRSA. We will start with four cases and then describe the IDSA recommendations.
These cases will highlight the recent updates to the Infectious Disease Society’s Practice Guidelines for the management of cellulitis and soft tissue infections. It is vital that emergency providers stay current with their clinical judgment in disposition as well as the use of appropriate antibiotic therapy.
Take Home Points
  1. Patients with uncomplicated cellulitis, with no co-morbidities, and without purulence, require coverage for MSSA with penicillins or first-generation cephalosporins.
  2. Patients with non-purulent cellulitis requiring admission only need coverage for MSSA and not MRSA.
  3. Purulent cellulitis requires coverage for MRSA.
  4. Necrotizing fasciitis requires broad-spectrum coverage, and, most importantly, immediate surgical consultation for debridement.
  5. Know your hospital’s antibiogram and availability of timely outpatient follow-up."