2. Non-pharmacologic Elevate the affected area to facilitate gravity drainage of edema and inflammatory substances – Patients with edema may benefit from treatment with compressive stockings and diuretic therapy Treat underlying conditions – Tinea pedis, lymphedema, and chronic venous insufficiency

3. Pharmacologic Empiric antibiotic therapy should include activity against beta-hemolytic streptococci and S. aureus Empiric therapy for MRSA should be initiated for patients with recurrent infection in the setting of underlying predisposing conditions, patients with a previous episode of proven MRSA infection, and patients with systemic toxicity

4. Pharmacologic Patients presenting with an initial episode, in the absence of significant comorbidities, should be treated with agents that have activity against beta-hemolytic streptococci and methicillin-susceptible S. aureus Patients with mild cellulitis can be treated with oral antibiotics Patients with signs of systemic toxicity or erythema that has progressed rapidly should be treated initially with parenteral antibiotics Patients with recurrent infection in the setting of underlying predisposing conditions or with a previous episode of proven MRSA infection should receive empiric coverage for beta-hemolytic streptococci and MRSA

5. Pharmacologic Fluoroquinolones have been approved for the treatment of uncomplicated cellulitis but are not adequate for treatment of MRSA infections

6. Medications given to the patient Clindamycin 100mg/SIVP every 6 hours Amikacin 165mg/SIVP once a day every 24 hours Paracetamol 120mg/5ml, 5ml every 6 hours as needed for pain and fever

7. Cellulitis Common pathogens – S. aureus, Group A streptococcus Drugs of first choice – Penicillinase-resistant cephalosporin (third-gen) Alternative – Vancomycin, clindamycin, linezolid

8. Clindamycin (p. 751) Inhibits protein synthesis by interfering with the formation of initiation complexes and with aminoacyl translocation reactions Binds to the 50S subunit bacterial ribosome Inhibits streptococci, staphylococci, and pneumococci Bacteroides sp. And other anaerobes are usually susceptible Enterococci and gram-negative aerobes are resistant

9. Clindamycin 90% protein bound Penetrates well into most tissues, except brain and cerebrospinal fluid Penetrates well into abscesses and is actively taken up and concentrated by phagocytic cells Metabolized in the liver, and both active drug and active metabolites are excreted in bile and urine Half life: 2.5hours; 6hours in anuric patients No dosage adjustment needed for renal failure

10. Clindamycin Adverse effects – Diarrhea, nausea, skin rashes – Impaired liver function – Neutropenia

11. Amikacin (p. 760, 776) Inhibits gram-negative enteric bacteria including proteus, pseudomonas, enterobacter, and serratia Nephrotoxic and ototoxic