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Chapter 24. Skin and Soft Tissue Infections

AB, a 30-year-old man who does not have any significant previous medical history nor drug allergies, was admitted to the hospital with an abscess and associated cellulitis. After appropriate drainage of the abscess, AB was initiated on intravenous vancomycin therapy. The culture from the incision and drainage grew community-associated methicillin-resistant Staphylococcus aureus (caMRSA). AB’s clinical status improved with 2 days of vancomycin therapy and thus will be discharged home with an oral antibiotic to finish his therapy. Which of the following antibiotic(s) is/are appropriate step-down options for AB? Select all that apply.

a. Cephalexin

b. Minocycline

c. Tigecycline

d. Trimethoprim-sulfamethoxazole

Answer b is correct. Minocycline is an oral antibiotic active against caMRSA used for the treatment of skin and soft tissue infections (SSTIs).

Answer d is correct. Trimethoprim-sulfamethoxazole is an oral antibiotic active against caMRSA and can be used for the treatment of SSTIs.

Answer a is incorrect. As the culture was positive for caMRSA, any step-down therapy chosen should have activity against it. Cephalexin is not active against caMRSA.

Answer c is incorrect. Tigecycline, while active against caMRSA, is only available as a parenteral formulation.

AB, a 30-year-old man who does not have any significant previous medical history nor drug allergies, was admitted to the hospital with an abscess and associated cellulitis. After appropriate drainage of the abscess, AB was initiated on intravenous vancomycin therapy. The culture from the incision and drainage grew community-associated methicillin-resistant Staphylococcus aureus (caMRSA). AB’s clinical status improved with 2 days of vancomycin therapy and thus will be discharged home with an oral antibiotic to finish his therapy. The medical team chose to prescribe sulfamethoxazole-trimethoprim (SMZ/TMP) for AB’s cellulitis. Which of the following organisms commonly encountered in cellulitis are covered/treated with SMZ/TMP (Septra)? Select all that apply.

a. Methicillin-sensitive S. aureus (MSSA)

b. Mycoplasma pneumoniae

c. Pneumocystis jiroveci

d. Methicillin-resistant S. aureus

Answer b is incorrect. TMP/SMZ does not have activity against atypical bacteria such as M. pneumoniae. Additionally, atypical bacteria (eg, M. pneumoniae) are not causative organisms of cellulitis.

Answers a and d are correct. TMP/SMZ DOES have activity against many gram-positive organisms including S. aureus (MSSA and community-associated methicillin-resistant Staphylococcus aureus [caMRSA]).

Answer c is incorrect. TMP/SMZ DOES have activity against P. jiroveci. Often times you will see TMP/SMZ used as prophylaxis in severely immunocompromised patients. However, P. jiroveci would not be a ...

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