Cellulitis in special conditions: (from 熱病, 37th edition; Fitzpatrick 7th edition)
Bite: Remember tetanus prophylaxis
n Bat: Streptococci & Staphylococcus from skin; rabies
1. Primary regimens: amoxicillin-clavulanate 875/125mg po bid or 500/125mg po tid
2. Alternative regimen: Doxycycline 100mg po bid
n Cat: Pasteurella multocida, Staphylococcus aureus
1. Primary regimen: amoxicillin-clavulanate 875/125mg po bid or 500/125mg po tid
2. Alternative regimen: Cefuroxime axetil 0.5gm po q12h or doxycycline 100mg po bid
n Dog: Pasterurella multocida, Staphylococcus aureus, Bacteroides species, Fusobacterium species, EF-4, Capnocytophaga
1. Primary regimen: amoxicillin-clavulanate 875/125mg po bid or 500/125mg po tid
2. Alternative regimen: Clindamycin 300mg po qid + fluoroquinolone (adults) or Clindamycin + TMP-SMX (children)
n Human: Viridans strep, Staphylococcus epidermidis, corynebacterium, Staphylococcus aureus, eikenella, bacteroides, peptostreptococcus:
1. Early (not yet infected): amoxicillin-clavulanate 875/125mg po bid x 5 days
2. Later (signs of infection, usually in 3-24 hours):
u ampicillin-sulbactam 1.5gm iv q6h
u cefoxitin 2gm iv q8h
u ticacillin-clavulanate 3.1gm iv q6h
u piperacillin-tazobactam 3.375gm iv q6h or 4.5gm q8h
u Penicillin allergy: clindamycin + (either ciprofloxacin or TMP-SMX)
n Rat: Spirillum minus & Stretpbacillus moniliformis
1. Primary regimens: amoxicillin-clavulanate 875/125mg po bid
2. Alternative regimens: doxycycline
Contaminated with water
n Sea water-contaminated: Vibrio vulnificus, Vibrio damsela
1. Primary regimens: Ceftazidime 2gm iv q8h + doxycycline 100mg iv/po bid
2. Secondary regimens: Cefotaxime 2gm iv q8h or ciprofloxacin 750mg po bid or 400mg iv bid
n Fresh and brackish water: Aeromonas hydrophila
1. 3rd-generation cephalosporins, fluoroquinolones, and aminoglycosides (but not streptomycin):ex. ampicillin-sulbactam /ticacillin-clavulanate/ piperacillin-tazobactam + vancomycin 1g iv q12h或ciprofloxacin/levofloxacin iv + vancomycin 1gm iv q12h
Bite: Remember tetanus prophylaxis
n Bat: Streptococci & Staphylococcus from skin; rabies
1. Primary regimens: amoxicillin-clavulanate 875/125mg po bid or 500/125mg po tid
2. Alternative regimen: Doxycycline 100mg po bid
n Cat: Pasteurella multocida, Staphylococcus aureus
1. Primary regimen: amoxicillin-clavulanate 875/125mg po bid or 500/125mg po tid
2. Alternative regimen: Cefuroxime axetil 0.5gm po q12h or doxycycline 100mg po bid
n Dog: Pasterurella multocida, Staphylococcus aureus, Bacteroides species, Fusobacterium species, EF-4, Capnocytophaga
1. Primary regimen: amoxicillin-clavulanate 875/125mg po bid or 500/125mg po tid
2. Alternative regimen: Clindamycin 300mg po qid + fluoroquinolone (adults) or Clindamycin + TMP-SMX (children)
n Human: Viridans strep, Staphylococcus epidermidis, corynebacterium, Staphylococcus aureus, eikenella, bacteroides, peptostreptococcus:
1. Early (not yet infected): amoxicillin-clavulanate 875/125mg po bid x 5 days
2. Later (signs of infection, usually in 3-24 hours):
u ampicillin-sulbactam 1.5gm iv q6h
u cefoxitin 2gm iv q8h
u ticacillin-clavulanate 3.1gm iv q6h
u piperacillin-tazobactam 3.375gm iv q6h or 4.5gm q8h
u Penicillin allergy: clindamycin + (either ciprofloxacin or TMP-SMX)
n Rat: Spirillum minus & Stretpbacillus moniliformis
1. Primary regimens: amoxicillin-clavulanate 875/125mg po bid
2. Alternative regimens: doxycycline
Contaminated with water
n Sea water-contaminated: Vibrio vulnificus, Vibrio damsela
1. Primary regimens: Ceftazidime 2gm iv q8h + doxycycline 100mg iv/po bid
2. Secondary regimens: Cefotaxime 2gm iv q8h or ciprofloxacin 750mg po bid or 400mg iv bid
n Fresh and brackish water: Aeromonas hydrophila
1. 3rd-generation cephalosporins, fluoroquinolones, and aminoglycosides (but not streptomycin):ex. ampicillin-sulbactam /ticacillin-clavulanate/ piperacillin-tazobactam + vancomycin 1g iv q12h或ciprofloxacin/levofloxacin iv + vancomycin 1gm iv q12h
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