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Are PIC Lines And IV Effective At Treating Streptococcus Equi?

Posted on Mon, 8 Oct 2018

Question: My wife has had an infection in her knee since May. It is streptococcus Equine. I hope the DR has access to my dashboard. Any way she is taking Keflex, 500 mg. four a day. Earlier she had a PIC line and later after they took that out she got IV every day for about six weeks or so. Since then her knee to me looks OK but is still painful and somewhat swollen. Her infectious disease DR said the markers for the infection are down. She had two aspirations in her knee but Tricore lost both. She is wondering if maybe a PIC line or IV might be better than Keflex? Is that rational or is Keflex just as good as an IV daily?

Answered by Dr. Grzegorz Stanko (33 minutes later)

Brief Answer:

Please attach an antibiogram.

Detailed Answer:

Hello,

Can you please attach an antibiogram of the S.Equine diagnosed from the knee fluid?

Thinking about joint infection, it is very necessary to consider antibiotic penetration to joints and bones.

Please note that in this kind of tissues, not all antibiotics will be present in therapeutic concentration (the amount necessary to kill bacteria).

So if its i.v. or oral antibiotic is not the most important factor. I.V. antibiotics should be given as a therapy beginning and switched to oral antibiotic after a week or two.

Please note that oral absorption of some antibiotic is comparable to i.v.

Keflex seems to be not the best choice. However, it all depends on the antibiogram. So please attach it.

Hope I have answered your query. Let me know if I can assist you further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Grzegorz Stanko (22 hours later)

I don't know if I can get an antibiogram. Would her infectious disease DR have that? No one has mentioned that. Although I presume while in the hospital they did an analysis of the infection and decided on the antibiotic that they are using. They first gave her Invanz but it made her psychotic so they changed to Rocophin and now Keflex. XXXXXXX

Answered by Dr. Grzegorz Stanko (16 hours later)

Brief Answer:

Knee fluid aspiration seems advisable.

Detailed Answer:

Hello,

They must have an antibiogram. How about aspirating knee fluid and check it again? Sometimes bacteria become resistant to current treatment and antibiotic must be changed. Especially if the symptoms do not disappear.

Hope I have answered your query.

Take care

Regards,
Dr Grzegorz Stanko, General Surgeon

Note: For further inquiries on surgery procedure and its risks or complications book an appointment now

Above answer was peer-reviewed by : Dr. Remy Koshy