12-16-2008, 03:41 PM
A 45-year-old woman was bitten on her right hand by her house cat during somewhat aggressive play. There was a small amount of bleeding from two puncture wounds on the palm. The patient promptly washed the wound and applied antiseptic.
One day later, she developed erythema at the wound site, which immediately began to spread circumferentially, most markedly toward the wrist. The wound is now quite painful, and the patient notes slight chilling and possible fever. She developed hives and generalized pruritus when given amoxicillin for a sore throat 4 years ago.
On physical examination, temperature is 37.2 °C (99 °F), pulse rate is 102/min, respiration rate is 18/min, and blood pressure is 162/102 mm Hg. There is swelling, erythema, and tenderness of the thenar eminence of the right hand with irregular spreading of the erythema that is now proximal to the wrist. Nondraining puncture marks are evident. Cardiopulmonary examination is unremarkable.
Laboratory Studies
Hemoglobin
12.9 g/dL (129 g/L)
Hematocrit
38.9%
Leukocyte count
14,750/µL (14.7 × 109/L) with 95% neutrophils and 5% lymphocytes
Blood urea nitrogen
22 mg/dL (7.86 mmol/L)
Serum creatinine
1.3 mg/dL (114.95 µmol/L)
Serum electrolytes
Normal
Which of the following is the most appropriate outpatient treatment regimen for this patient?
A Doxycycline
B Ciprofloxacin
C Trimethoprim“sulfamethoxazole plus clindamycin
D Cephalexin plus metronidazole
E Amoxicillin“clavulanate
One day later, she developed erythema at the wound site, which immediately began to spread circumferentially, most markedly toward the wrist. The wound is now quite painful, and the patient notes slight chilling and possible fever. She developed hives and generalized pruritus when given amoxicillin for a sore throat 4 years ago.
On physical examination, temperature is 37.2 °C (99 °F), pulse rate is 102/min, respiration rate is 18/min, and blood pressure is 162/102 mm Hg. There is swelling, erythema, and tenderness of the thenar eminence of the right hand with irregular spreading of the erythema that is now proximal to the wrist. Nondraining puncture marks are evident. Cardiopulmonary examination is unremarkable.
Laboratory Studies
Hemoglobin
12.9 g/dL (129 g/L)
Hematocrit
38.9%
Leukocyte count
14,750/µL (14.7 × 109/L) with 95% neutrophils and 5% lymphocytes
Blood urea nitrogen
22 mg/dL (7.86 mmol/L)
Serum creatinine
1.3 mg/dL (114.95 µmol/L)
Serum electrolytes
Normal
Which of the following is the most appropriate outpatient treatment regimen for this patient?
A Doxycycline
B Ciprofloxacin
C Trimethoprim“sulfamethoxazole plus clindamycin
D Cephalexin plus metronidazole
E Amoxicillin“clavulanate