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Challenging Question #9

1871 Views 5 Replies 4 Participants Last post by  atr88
9) A 10 year-old male is brought to the urgent care clinic by his grandmother. She tells you that her cat bit the boy on the hand approximately 8 hours ago while he was teasing the animal. He just told his grandmother a few minutes ago because his hand started to hurt. The cat is up to date on all immunizations, as is the patient with his as their immunization records showed.

The child is otherwise healthy except for recurrent otitis media and mild season allergies. He is allergic to penicillins as he developed a rash the last time he took the antibiotic. On examination, vital signs are: BP 106/68 mmHg, Temp 99 F, Resp 17/min, Pulse 92/min. The physical exam is remarkable only for a deep pair of puncture wounds to the right thenar eminence, mild surrounding erythema, and localized tenderness to palpation.

After appropriate wound care in the urgent care clinic, what is the best antibiotic regimen for this patient?

A) cephalexin and trimethoprim-sulfamethoxazole
B) clindamycin and trimethoprim-sulfamethoxazole
C) azithromycin and cephalexin
D) azithromycin and trimethoprim-sulfamethoxazole
E) ciprofloxacin and clindamycin

Explanation will be posted soon....
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causative agent is psteurella multocida that responds well to amoxicillin(augmentin) but the patient has allergy to penicillins so
we should use clindamycin+ciprofloxacin or trimethoprim-sulfamethoxazole or azithromycin
two choices ;E AND B
but we can't use ciprofloxacin at this age so choice B is correct
although pasteurella multocida is the most causative of infection in cat bite and it's sensitive to azithromycin ,but we shouldn't forget that other bacterias like anaerobes can be present and we must cover them ;clindamycin will do it for us as it covers both gram positive cocci and anaerobes.
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