From: Gill Winnik ([log in to unmask])> Child with foot cellulitis and streaking lymphangitis to the knee plus fever, but not toxic looking...In your practice would this child be admitted?
--> From the information given thus far - no.
Seems like a well patient with a normal progress of infection and able to mount a fever response. Just add antibiotics.
> Would you admit if he had no fever?
--> Still generally not. I WOULD admit if I thought there was a reason to suspect a deficient systemic response to infection or that might not tolerate antibiotics or patient was septic.
It is possible to consider a step of initial IV dose of antibiotics, but my preference is to give a big oral loading dose and wait a couple of hours to make sure it has got in and not been puked up... No reason give to suspect malabsorption...
> Would a WBC be a factor in your dispo
--> I would not usually do a count, but if one was already done and showed a count which is too low...
From: Prater, Samuel J ([log in to unmask])> We would place in observation for IV antibiotics
--> Why IV? Patient is well. What advantage does an IV dose have over an oral one followed by a couple of hours' observation to ensure it's tolerated? Please explain.
From: Bill Schroeder ([log in to unmask])> I tend to admit if there is significant streaking. If its only a few cm of lymphangitis, no fever and well appearing then I'll consider outpt management with close follow up.
--> This does not compute for me. A few cm is going to be followed by the rest of them. The infection is not going to be fought and beaten some way up the lymph vessel - it will get up to the nodes. That's how it's supposed to be.
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