10.有關皮膚軟組織感染之處置,下列何者最不適當?
(A)被貓咬傷建議以amoxicillin/clavulanate 875/125 mg BID PO治療
(B)蜂窩性組織炎(cellulitis)一定要注射抗生素至少5天
(C)治療反應不佳的蜂窩性組織炎須考慮抗藥性金黃葡萄球菌(S. aureus)感染
(D)壓瘡(pressure sore)可用silver sulfadiazine藥膏治療
統計: A(847), B(3812), C(141), D(1025), E(0) #2180214
詳解 (共 10 筆)
補樓上nejs內容
輕中度的非化膿性蜂窩性組織炎,抗生素選擇為非後線的"cephalosporins"或"penicillins"為主,例如cephalexin或dicloxacillin等。
口服治療失敗,或符合兩項以上SIRS標準,靜脈注射抗生素選擇則是cefazolin或ceftriaxone或penicllin G。
嚴重的非化膿性蜂窩性組織炎,需判高抗藥性菌種 (MRSA) 感染的可能性,如果高度懷疑或確認,則必須使用可有效對抗MRSA的抗生素,如vancomycin、linezolid、daptomycin或tigecycline等。
治療療程當然須要看臨床反應決定,建議治療開始後48~72小時 (2~3天) 應評估臨床反應,包括全身性病徵、局部病灶情況等。
非住院病人一般口服抗生素治療5~10天,免疫功能不全可延長治療7~14天。
幫大家整理cellulitis :
上為非化膿/下為化膿


from:NEJS
全文章寫得比較好,關鍵字:蜂窩性組織炎 報告用大圖

Cellulitis
Patients with nonpurulent cellulitis (eg, cellulitis with no purulent drainage or exudate and no associated abscess) should be managed with empiric therapy for infection due to beta-hemolytic streptococci and methicillin-susceptible Staphylococcus aureus (MSSA). Common options are cefazolin for intravenous therapy and cephalexin for oral therapy
The duration of therapy should be individualized depending on clinical response. In general, five days of therapy is appropriate for patients with uncomplicated cellulitis whose infection has improved within this time period. Extension of antibiotic therapy (up to 14 days) may be warranted in the setting of severe infection, slow response to therapy, or immunosuppression.
Ref: UpToDate
9F,上面那題應該是(B) Pasteurella spp.吧