jswain34
Well-known member
I just explained to you why he would have given him antibiotic. I understand the mechanism of antibiotic resistance, and the need for responsible prescribing. I definitely dont need you to try to educate me on it, thanks.
As i said, the skin flora (eg staph and strep) are what will commonly cause a superimposed skin infection after a potential insect bite. They are both gram positive. All of the antibiotics i listed above cover both. Keflex has good coverage as well, essentially everything youd want to cover for except MRSA.
You dont culture every single little wound that comes into the ER. We get all caught up in "the appropriate diagnosis" (ie. putting a fancy name to something) when it is still treated the same regardless of what the fancy bacteria name comes back as. Its an absolute waste if money when 90+% of skin infections are caused by the same couple of pathogens that are all treated with the same few antibiotics. As i said above, you engage in shared decision making with the patient. Lay out the positives of starting the abx and the negatives of them, then come to a decision together based on what the patient feels is best when they understand both sides. State the fact you're not 100% sure its actually a bacterial infection but it does seem to be showing signs its going that way. If you think the patient is responsible enough this might be a good time for a "wait and see" prescription.
We weren't in the room with DC and the ER doc. You're just up in arms over something that you really only have about 1/3 of the story on, the part that he has this wound and you disagree with someone who looks at skin infections several times a day for their job. You want to treat people like DC? Move to the US, go back to school, get a degree and change the world man.
As i said, the skin flora (eg staph and strep) are what will commonly cause a superimposed skin infection after a potential insect bite. They are both gram positive. All of the antibiotics i listed above cover both. Keflex has good coverage as well, essentially everything youd want to cover for except MRSA.
You dont culture every single little wound that comes into the ER. We get all caught up in "the appropriate diagnosis" (ie. putting a fancy name to something) when it is still treated the same regardless of what the fancy bacteria name comes back as. Its an absolute waste if money when 90+% of skin infections are caused by the same couple of pathogens that are all treated with the same few antibiotics. As i said above, you engage in shared decision making with the patient. Lay out the positives of starting the abx and the negatives of them, then come to a decision together based on what the patient feels is best when they understand both sides. State the fact you're not 100% sure its actually a bacterial infection but it does seem to be showing signs its going that way. If you think the patient is responsible enough this might be a good time for a "wait and see" prescription.
We weren't in the room with DC and the ER doc. You're just up in arms over something that you really only have about 1/3 of the story on, the part that he has this wound and you disagree with someone who looks at skin infections several times a day for their job. You want to treat people like DC? Move to the US, go back to school, get a degree and change the world man.
