A 33-year-old male with type 1 diabetes presents with a two day history of pain, swel

Discussion in 'MRCP Forum' started by Santosh Jadhav, Nov 8, 2013.

  1. Santosh Jadhav

    Santosh Jadhav Active Member

    Question: 56

    A 33-year-old male with type 1 diabetes presents with a two day history of pain, swelling and
    redness in his left middle finger. This began after he pricked his finger in the garden whilst
    pruning a bush.
    His diabetic control has been quite reasonable with a HbA1c of 7.1% (3.8-6.4) on basal bolus
    insulin consisting of Lispro tds and Humulin I in the evenings.
    On examination he has a painful, red and swollen middle finger with the redness extending
    to the metacarpophalangeal joint. He is diagnosed with cellulitis. Hand movements are
    intact.
    What is the most appropriate treatment for this patient?
    (Please select 1 option)
    Admit to hospital for IV antibiotics
    Oral clindamycin and flucloxacillin
    Oral flucloxacillin only
    Oral metronidazole only
    Oral penicillin V only

    The patient has digital cellulitis and the most likely organisms responsible are Strep.
    pyogenes or Staph. aureus.
    The most appropriate treatment is clindamycin and flucloxacillin, which covers the majority of
    organisms responsible for cellulitis. If there is any suspicion of tendon involvement the
    plastics or orthopaedics team (depending on local policy) should be asked to review and
    intravenous antibiotics initiated.
    Intact hand movements in this case make this less likely, and therefore a trial of oral
    antibiotics is appropriate.
    The patient should be closely monitored, and readmitted for intravenous antibiotics should
    there fail to be significant improvement within 48 hours

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