Wednesday, October 21, 2009

Is cephelexin ok for staph impetigo?

my friend had a bug bite get infected and turn into a staph skin infection. i was taught first line for a staph infection was a methicillin derivitive, a carbapenem or 2nd gen cephalosporin and the cephelexin isnt a good choice because of high resistance. do doctors prescribe cephelexin for staph infections regularly? i just told her to give the cephelexin 2 days and if it gets worse she runs a high fever or it doesnt get any better to get something else
Depends on where you live. In my neighborhood (south side of Chicago) there is such a high incidence of community-acquired methicillin-resistant Staph. aureus (MRSA) that clindamycin or Bactrim are routinely prescribed for skin infections. In areas where MRSA is not an issue, cephalexin is fine. Your friend's doctor should know if you're in a MRSA problem area.To the other answerer: Staph impetigo is usually diagnosed clinically. Culturing skin infections is often low yield because you will have lots of endogenous flora mucking things up. The only reasons to swab a skin infection is if there is a suspicion for antibiotic resistance (e.g., MRSA) or if the infection is so bad as to be life-threatening (i.e., there are systemic signs).
What did the lab sensitivity testing show? This test would be routine with the culture identifying a Staph.
Cephalexin is the drug of choice in this case. Cabapenem derivatives (Lorabid) isn't actually used at all for skin infections (at least in this area of the country - LOL I don't even think we carry it in most pharmacies around here). I know, I know - most people want high powered antibiotics especially when they hear staph infection. But really Keflex *cephalexin* IS the drug of choice (meaning this is the drug that is indicated to be used FIRST) for this diagnosis. One doesn't normally suspect an MRSA (methicillin resistant Staph Aureus) infection right off the bat from a simple bug bite. Two days certainly isn't time enough to panic if the infection doesn't get any better. However if friend does run a high fever, or it does get worse, of course contact the prescriber and let them know about the change in status of the infection. Also if there is any 'streaking' read streaks running from the site of infection, call and let the prescriber know as well. But DO keep taking the medicine until you talk to your prescriber as he/she did precisely the right thing for the condition. You paid them to do a job, now do the next indicated thing =)

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