Skip to Main Content

Instructors can request access to the Casebook Instructor's Guide on AccessPharmacy. Email User Services (userservices@mheducation.com) for more information.

LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Evaluate the signs and symptoms of skin and soft tissue infections (SSTIs).

  • Recommend appropriate empiric nonpharmacologic and pharmacologic treatment options for patients presenting with SSTIs.

  • Differentiate between the definition and clinical manifestations of mild, moderate, and severe SSTI.

  • Compare and contrast the clinical characteristics and presentation of a purulent vs nonpurulent SSTI.

  • Design an antimicrobial treatment regimen for purulent and nonpurulent SSTIs that are mild, moderate, or severe.

  • Develop monitoring parameters for nondrug and pharmacologic treatment of SSTIs.

  • Identify treatment modalities for decolonizing a patient with recurrent purulent SSTIs.

PATIENT PRESENTATION

Chief Complaint

“I have a boil on my butt, and I cannot sit down for class.”

HPI

Jimmie Chipwood is a 19-year-old college student who presents to the ED with a new-onset “boil” on his right buttock. He noticed some pain and irritation in the right buttock area over the past week but thought it was due to having slid into second base during a baseball game. The pain gradually increased over the next few days, and he went to the student health center, where they cleaned the wound and gave him a prescription for clindamycin 300 mg QID for 7 days. They recommended he try to keep the area covered until the antibiotic began to work. Today (7 days later), Jimmie returned to the student health center for further evaluation and was referred to the ED for further care for his continued SSTI. At the ED, Jimmie says the area on his buttock is worse, and he cannot sit down for class. He reports only partial adherence to the clindamycin regimen, because he often forgets to take it and says it makes him nauseated.

PMH

Noncontributory

Surgical History

Appendectomy 4 years ago

Repair of left ACL tear 2 years ago

SH

Denies any alcohol or illicit drug use.

Meds

Clindamycin 300 mg PO QID × 7 days (prescribed at student health center visit 1 week ago; patient did not complete full course).

All

Penicillin (hives as a child)

Immunizations

Up-to-date per student health center records

ROS

Negative except for complaints noted in HPI

Physical Examination

Gen

WDWN Caucasian man in no acute distress, but with noticeable pain when he walks and tries to sit

VS

...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.