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The combination of doxycycline or fluoroquinolone with metronidazole can also be used in those with a b-lactam allergy.

by | Nov 22, 2022 | Medicine | 0 comments

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please respond to the following discussion post at the end of the instructions. Please use your in text citation and also reference according to the APA guidelines. Use your own words, do not use direct quotes on this order. Use scholarly peer reviewed references within the last 5 years to support your response. please avoid using consumer level resources such as drugs. com or mayoclinic.com. please use the appropriate sources this is professional level course. respond the following discussion board post using peer reviewed scholarly sources to support your answer. G.M: Skin and soft-tissue infections (SSTI) can involve one or many layers of skin including the muscle and fascia. Bacterial SSTIs are classified as primary or secondary infections. Human bite wounds are considered secondary infections. SSTIs can also be classified as complicated or uncomplicated; complicated SSTIs can involve surgical intervention. The skin is the primary defense against infections unless it is penetrated among other factors. SSTIs have diverse etiologies. Hand SSTIs are the third frequent type of bites with dog bites being first and cat bites second. Infection in hand SSTIs occurs in 10%-50% of patients. Human bites, especially closed-fist injuries, are more serious than animal bites. The force of a punch can break the metacarpophalangeal joint causing a direct entry for the bacteria to enter in either the joint or bone. The severity of the infection depends on the type of microorganism involved, the patient’s immune status, and the location of injury. Microorganisms seen in human bite wounds include: Eikenella corrodens, S. aureus, streptococci, Corynebacterium spp., Bacteroides spp., and Peptostreptococcus spp. Most hand infections are polymicrobial. The diagnostic criteria of SSTIs are warmth, swelling, erythema, tenderness, pain, dysfunction, and presence of drainage. Severe SSTIs can include systemic symptoms (DiPiro et al., 2020; Ki & Rotstein, 2008).
Most patients do not seek help in a hand SSTI until infection is already present. For a hand SSTI, diagnostic evaluation may include having blood cultures, swab and culture, needle aspiration, x-ray, and an ultrasound. Cultures should be obtained from the infected wound; wounds >24 hours after injury that show no signs of infection do not need to be cultured. Before swabbing, the wound should be cleaned with normal saline or sterile water irrigation. It should be washed with soap or povidone-iodine. Radiologic tests should be performed if bone or joint damage is suspected. Needle aspiration is useful in patients with fluid-filled vesicles. An x-ray is useful in detecting bone involvement and air in the tissues. An ultrasound is useful in detecting crepitus, an abscess, or fascial inflammation. Debridement and exploration may be done depending on the severity of the wound (AAP, 2021). A thorough assessment is needed to prevent loss of function in the hand. The hand should be immobilized depending on the seriousness of the injury. If edema is present, the arm should be elevated until resolved. HIV, hepatitis B and C could be transmitted through a bite, therefore, any information on the biter is useful. Virus-containing blood in the saliva is what can make HIV transmissible; those exposed may be given antiretroviral therapy. A tetanus toxoid and antitoxin may be given as well. Primary closure of a human bite is generally not recommended (AAP, 2021; DiPiro et al., 2020; Ki & Rotstein, 2008). Since a close-fist injury is severe, the patient should be admitted for 2-3 days for close observation (Ki & Rotstein, 2008).
Prophylactic antibiotic treatment is dependent on wound severity and the patient’s immune status, however, those with a hand or face injury are given treatment regardless of status. Prophylactic treatment is generally for 3-5 days. Those with a clenched-fist bite injury are treated differently; they are generally given IV antibiotics. They are given ampicillin-sulbactam or piperacillin-tazobactam. The pediatric dose of piperacillin-tazobactam is 250-350 mg/kg/day IV in three to four divided doses. If the patient is allergic to penicillin, they can be given extended spectrum cephalosporin or trimethoprim-sulfamethoxazole plus clindamycin (AAP, 2021; DiPiro et al., 2020). The combination of doxycycline or fluoroquinolone with metronidazole can also be used in those with a B-lactam allergy. Therapy is usually given for 7-14 days. No improvement seen in 24 hours warrants a debridement. The patient should also be seen by physical therapy to prevent loss of function in the hand (DiPiro et al., 2020).

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