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Suggest treatment for cellulitis

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Posted on Mon, 17 Aug 2015
Question: My husband woke up this morning with a fever (100.8 deg F), slight nausea, bad headache, swollen and red right foot. Last night at dinner he was bitten by an insect on that foot. He also had a tick embedded in his head about 10 days ago--no rash however. We went to an urgent care facility this morning. The diagnosis was cellulitis with the possibility of Lyme disease. We filled two prescriptions, one for doxycycline, the other for cephalexin. He took both antibiotics, and two Tylenol around 11 am. He feels no better, and just about half an hour ago. vomited a watery yellow fluid (bile). The redness has not moved up his leg. His foot hurts. He just took two ibuprofen. Should we wait this out, or do the symptoms seem dangerous enough to go to an emergency room? Thank you.
doctor
Answered by Dr. Panagiotis Zografakis (24 minutes later)
Brief Answer:
if the leg is not getting worse you can give treatment a chance

Detailed Answer:
Hello,

cellulitis is a serious infection that requires a vigilant patient when treated at home. Since the doctor found no concerning signs during the clinical examination, I believe that he can give a chance to the antibiotics. It's too soon to see something better. He's going to need at least a couple of days under treatment before any improvement.

If he has signs of worsening or any of the following then he should visit the ER at once:
- low systolic blood pressure (less than 90mmHg)
- worsening tachycardia (increased heart rate), particularly if more than 120/minute.
- too many breaths per minute (more 30 means very serious infection)
- cognitive impairment or stupor: if he sleeps all the time and he can't wake up for more than a moment or if he mumbles or talks nonsense.
- reduced urine output: less than 500mL per day are too low.

Any new symptom or sign would be a good reason to visit the doctor again. Also, if he can't receive adequate hydration (enough fluids that is) due to his nausea and vomiting or if he can't receive the antibiotics for the same reason then hospitalization might be required.

I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Panagiotis Zografakis (22 minutes later)
Thank you so much!
XXXXXXX and XXXXXXX
doctor
Answered by Dr. Panagiotis Zografakis (20 minutes later)
Brief Answer:
You're welcome

Detailed Answer:
Glad to help! My best wishes for a speedy recovery!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Panagiotis Zografakis (17 hours later)
This morning my husband feels much better. However, his foot is still red (less red than yesterday I think, and more of a patchy redness than overall redness). However, the redness is higher up on his ankle I think than it was yesterday. There are NO red streaks up his leg (which we were told to watch for). We would like to avoid going to an emergency room today on a weekend,, and he will go to his doctor tomorrow morning, but does the extra redness on the ankle mean that he should go to an emergency room today?

Thanks so much,
XXXXXXX
doctor
Answered by Dr. Panagiotis Zografakis (22 minutes later)
Brief Answer:
it's better if you go

Detailed Answer:
Hi,

so, you've got an improving general condition but a spreading redness. If I had to choose the most important parameter between the two, then his general condition would probably be it. Despite that, spreading redness is concerning and should be assessed by a doctor. Blood tests may help a lot to determine the severity of his situation. A complete blood count and C-reactive protein are useful tests for that.

When my patients state that they feel better, I usually don't ask them to visit me at once. What I've mentioned in my first answer applies in such cases.

Kind Regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (1 hour later)
Again, thank you so much!
doctor
Answered by Dr. Panagiotis Zografakis (2 minutes later)
Brief Answer:
You're welcome

Detailed Answer:
Best wishes for XXXXX's health!

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

Internal Medicine Specialist

Practicing since :1999

Answered : 3691 Questions

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Suggest treatment for cellulitis

Brief Answer: if the leg is not getting worse you can give treatment a chance Detailed Answer: Hello, cellulitis is a serious infection that requires a vigilant patient when treated at home. Since the doctor found no concerning signs during the clinical examination, I believe that he can give a chance to the antibiotics. It's too soon to see something better. He's going to need at least a couple of days under treatment before any improvement. If he has signs of worsening or any of the following then he should visit the ER at once: - low systolic blood pressure (less than 90mmHg) - worsening tachycardia (increased heart rate), particularly if more than 120/minute. - too many breaths per minute (more 30 means very serious infection) - cognitive impairment or stupor: if he sleeps all the time and he can't wake up for more than a moment or if he mumbles or talks nonsense. - reduced urine output: less than 500mL per day are too low. Any new symptom or sign would be a good reason to visit the doctor again. Also, if he can't receive adequate hydration (enough fluids that is) due to his nausea and vomiting or if he can't receive the antibiotics for the same reason then hospitalization might be required. I hope you find my comments helpful! You can contact me again, if you'd like any clarification or further information. Kind Regards!