QuestionSBA
QuestionChoice
The signs and investigations so far point towards cellulitis. There are no convincing signs of a DVT. It is important to remember that the d-dimer will likely be raised due to infection in this case.
10028285
e
Test d-dimer
QuestionChoice
Benzylpenicllin has a fairly narrow spectrum. Most staphylococci are resistant to benzylpenicillin as they produce penicillinases. Flucloxacillin is resistant to these enzymes, and therefore is a good choice for treating cellulitis.
10028284
d
Benzylpenicillin
QuestionChoice
This is not appropriate; the patient is febrile, has evidence of cellulitis, and is bactaraemic. Culture results can be used to refine antibiotic choice, however treatment must be started as soon as possible.
10028282
b
Wait for sensitivity results before commencing antibiotics
QuestionChoice
This is not an unreasonable investigation if there is exudate present on the leg, however it is unlikely to change management. Antibiotics need to be administered.
10028283
c
Send a skin swab
QuestionChoice
The most likely diagnosis is cellulitis caused by staphylococci, which is also supported by the growth of clustered cocci. Flucloxacillin has good anti-staphylococcal activity and is usually the first line antibiotic for cellulitis (in the absence of a penicillin allergy).
10028281
a
Flucloxacillin
Concept
Chapter
2693
6047
Cellulitis
Topic
194
Infectious Diseases
18054
The first-line treatment for cellulitis is oral flucloxacillin, but in patients with a penicillin allergy, clindamycin or cephalexin (if the allergy is not severe) are typically used as alternatives.
A care home resident is admitted to hospital with rigors and fevers. They have a past medical history of diabetes and ischaemic heart disease. They have no known allergies.

On examination, they have a tender, erythematous area on the left shin.

Inflammatory markers are raised. Blood cultures show gram positive cocci in clusters.

What is the most appropriate management at this stage?
a