Patient Profile

26
CC:




HPI:
PMH:
ALL:
SH:

SOAP
S (Subjective data) :

( 1-3)

1

 2

3



O (Objective data) : -
A (Assessment):
(1)
(Impetigo)

impetigo contagiosa



gr.
A streptococci streptococcal impetigo impetigo
contaginosa S. aereus 10%
(vesicles)
(pus-filled blister)


(golden-yellow
crusts)

Ecthyma

(punch-out ulcer)
impetigo
contagiosa

-
-
-

-
-


-
(2)
- (Dermatitis)







- (Tinea infection)



- (Chicken pox and shingles)




Assessment therapy(1)
Practice Guidelines for the Diagnosis and
Management of Skin and Soft Tissue Infections

mupirocin retapamulin
5


S. aureus

7
methicillin dicloxacillin cephalexin
MRSA
doxycycline clindamycin sulfamethoxazole-
trimethoprim
 1

2 Practice
Guidelines for the Diagnosis and Management of Skin and Soft
Tissue Infections

IESAC(1,3)
1
 Dicloxacillin Cephalexin Clindamycin Amoxicillin-
clavulanate
Indication
(Impetigo)

Efficacy Dicloxacillin Cephalexin Clindamycin Amoxicillin-

clavulanate
Penicillins First-

generation Lincosamides Penicillin/-
cephalosporin lactamase
s inhibitor
Methicillin- 50s combinations
susceptible ribosome
Staphylococc
us aureus Methicillin-
(MSSA) susceptible
Staphylococc
us aureus time- Methicillin-
(MSSA) dependent susceptible
first- Staphylococcus
generation 4-5 aureus (MSSA)
cephalosporin

s

(MIC)

Dicloxacillin
time- Methicillin
dependent Penicillins resistance
Staphylococc
us aureus
(MRSA)
Methicillin-
(minimum susceptible
inhibitory Staphylococc
concentration us aureus
, MIC) (MSSA)

3-4







Safety(3) fatal hypersensitivi Neutropenia diarrhea/loose
hypersensitivi ty reactions, ( stools (9%),
ty, pseudomembr single nausea (3%),
Pseudomemb anous colitis, 600 mg oral skin rashes and
ranous colitis, diarrhea urticaria (3%),
diarrhea 2 vomiting (1%),
and vaginitis
neutrophil (1%)

hypersensitivity
) reactions
Adherence 250 mg qid 500 mg bid 300 mg qid 875/125 mg bid
po po po po
Cost 80 50 90 210
(
)

1 4


Clindamycin Methicillin resistance
Staphylococcus aureus (MRSA)
Amoxicillin-
clavulanate

Dicloxacillin Cephalexin

Cephalexin

Dicloxacillin
250 mg qid po
mupirocin
retapamulin mupirocin 2%

P (Plan):
Goals:
- Short term goal :

- Long term goal :
Therapeutic Plan:
- Dicloxacillin 250 mg qid po 7
- Mupirocin 2% apply to lession bid 5
Therapeutic monitoring: 5

Safety/Toxicity monitoring:
- Hypersensitivity Dicloxacillin

- Pseudomembranous colitis Dicloxacillin
Patient educations:
-



-



Future plan:
 Cephalexin 500 mg
bid po Amoxicillin-clavulanate 875/125 mg bid po



Methicillin resistance Staphylococcus aureus (MRSA)
Clindamycin 300 mg qid po

(1) Dennis L. Stevens. Alan L. Bisno. Practice Guidelines for the

Diagnosis and Management of Skin and Soft Tissue Infections: 2014
Update by the Infectious Diseases Society of America
[Internet]. 2014[cited 2016 july 18]; Available from:
http://www.idsociety.org/Guidelines/Patient_Care/IDSA_Practice_Gu
idelines/Infections_by_Organ_System/Skin___Soft_Tissue/Skin_and
_Soft_Tissue_Infections/
(2) . .
..2560. . 2016, p 100-120.
(3) C. RAYNER and W. J. MUNCKHOF. Antibiotics currently
used in the treatment of infections caused by Staphylococcus aureus.
Internal Medicine Journal. 2005; 35: S3-S16