Prior to responding to your enquiry adequately, I was curious if you could
share some additional details?
1.. What was the size of the abscess?
2.. Did this cherub have any systemic manifestations such as fever or
3.. Does the pediatrician or yourself have any concerns about an
immunosuppressed host? FTT? HIV? Neutropenia or lymphopenia? etc
4.. What were the sensitivities of the MRSA identified 4 months prior to
this visit? In particular, I am interested in MIC's to TMP-SMX &
Clindamycin, Macrolides? Was the D-test performed for inducible resistance
5.. Which region of the country do you and Valerie practice? One can
investigate CDC reports for prevalence of antibiotic resistance patterns of
MRSA in your community and hospital?
6.. Did you perform culture and sensitivity following the IND?
Thanks in advance.
Jay Pershad, M.D.
Division of Pediatric Emergency Medicine
Department of Pediatrics
University of Tennessee Health Sciences Center
Le Bonheur Children's Medical Center
Pediatric Emergency Specialists, PC
Pediatric Sedation Specialists, PC
Sorry to bother everyone with this topic again, but when it came around
the first time I thought "I'll probably never see that in my little town
ER". Well, in to my little ER yesterday came a 23 month old with a gluteal
abscess who had the same four months ago that grew MRSA. I remembered the
thread about using outpatient bactrim and discussed it with the Pediatrician
who agreed (this was after I and D) but the Infectious Disease consult nixed
the whole thing and insisted on admission with IV Vancomycin--should be
noted, small town = no peds ID, only adult trained ID.
Now I'm looking for evidence and can only remember our discussions here.
Does anyone have any articles I can pull for our ID specialist? Also, the
dose for Bactrim (I promise to write it down this time!).
Thank you for your time,
Mike Murphy, MD
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