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A 20-year-old college wrestler is evaluated for a painful lesion on his upper back. He first noted a small painful area 7 days ago, and the lesion enlarged and became more red and painful during the next several days. The patient states that other members of his wrestling team have developed similar lesions. His history is otherwise uneventful. Examination of the upper back reveals a 1 × 1-cm red, raised pustule that is tender to palpation, with a 4 × 4-cm area of surrounding erythema. The remainder of the physical examination, including vital signs, is normal.
The lesion is incised and drained. A culture is sent to the laboratory.
Which of the following is the most appropriate empiric treatment pending culture results?
A Levofloxacin
B Doxycycline
C Dicloxacillin
D Cephalexin
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ans is bbbb
This patient has a furuncle, and he is at risk for methicillin-resistant Staphylococcus aureus (MRSA) infection because of the history of similar lesions in members of his wrestling team. If at all possible, the most appropriate first step in this case would be to obtain a culture of the fluid to evaluate for MRSA, and this can best be accomplished with incision and drainage. Doxycycline is an appropriate empiric treatment for MRSA and can be administered while culture results are pending. Outbreaks of MRSA have occurred in several populations, including competitive athletes such as football players, rugby players, and wrestlers, likely owing to hygiene issues. Other populations at risk for this infection include military personnel, children, prisoners, homeless persons, men who have sex with men, and injection drug users. Community-acquired MRSA should be considered in populations at risk for this infection and in patients who do not respond well to empiric β-lactam therapy. Although furuncles and cutaneous skin abscesses constitute the most common presentation of community-acquired MRSA, cellulitis can also occur. In athletes playing on artificial turf, abscesses at the site of skin abrasions caused by turf contact are common.
Levofloxacin and other quinolones, in addition to first-generation cephalosporins such as cephalexin, do not effectively treat patients with MRSA. Other empiric antibiotic therapy for use in patients with suspected MRSA includes trimethoprim“sulfamethoxazole, minocycline, and clindamycin. In patients in whom MRSA or β-hemolytic streptococci are suspected, β-lactam, in addition to one of the above antibiotics, is recommended.
