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Suggest Treatment For Persistent Infection On Toe Caused By Centipede Sting
Question: Hello,
I have a persistent infection on the little toe of my left foot which followed a sting by a centipede which seemed to have been healed. I am a generally healthy and physically active (canoe paddling, hiking, beach walking, etc.) 74 yr. old female.
One week after the bite was healed, a blister appeared on my toe and the foot began to swell. I was treated by my MD with two antibiotics for 10 days and did some soaking and elevating of the foot. The swelling gradually went down but the blisters persisted. Since finishing the meds 9 days ago I have been applying various topical ointments. The foot may be a tiny bit swollen and the first and second blisters are not fully healed but are no longer filling up with liquid. However, one blister between the toes (the little one and the one next to it) remains.
Before culturing the liquid in the blister, my MD wrote prescription for both Floucinonide (first) and later SSD. He's also used a 3 in 1 antibacterial ointment in the office (it feels like a fishing expedition).
I received the culture results yesterday but NO new guidance or prescription. I've gone back to the first ointment (Floucinonide) since I read the bacteria is resistant to sulfur / sulfides.
A culture revealed the bacteria to be enterobacter cloacae. What treatment would you recommend at this point? I'm thinking of requesting a referral to an Infectious Disease MD. Do you think this is appropriate?
Thank you very much, Carole
I have a persistent infection on the little toe of my left foot which followed a sting by a centipede which seemed to have been healed. I am a generally healthy and physically active (canoe paddling, hiking, beach walking, etc.) 74 yr. old female.
One week after the bite was healed, a blister appeared on my toe and the foot began to swell. I was treated by my MD with two antibiotics for 10 days and did some soaking and elevating of the foot. The swelling gradually went down but the blisters persisted. Since finishing the meds 9 days ago I have been applying various topical ointments. The foot may be a tiny bit swollen and the first and second blisters are not fully healed but are no longer filling up with liquid. However, one blister between the toes (the little one and the one next to it) remains.
Before culturing the liquid in the blister, my MD wrote prescription for both Floucinonide (first) and later SSD. He's also used a 3 in 1 antibacterial ointment in the office (it feels like a fishing expedition).
I received the culture results yesterday but NO new guidance or prescription. I've gone back to the first ointment (Floucinonide) since I read the bacteria is resistant to sulfur / sulfides.
A culture revealed the bacteria to be enterobacter cloacae. What treatment would you recommend at this point? I'm thinking of requesting a referral to an Infectious Disease MD. Do you think this is appropriate?
Thank you very much, Carole
Brief Answer:
needs management and referral
Detailed Answer:
thank you for asking
Enterobacter infections can include bacteremia, lower respiratory tract infections, skin and soft-tissue infections, urinary tract infections (UTIs), endocarditis, intra-abdominal infections, septic arthritis, osteomyelitis, CNS infections, and ophthalmic infections. Enterobacter infections can necessitate prolonged hospitalization, multiple and varied imaging studies and laboratory tests, various surgical and nonsurgical procedures, and powerful and expensive antimicrobial agents.
they are a bit of a challenge and not easy to respond to.
the management of the enterobacter cloacae is with antibiotics and wound care.
following are the list of antibiotics advised and recommended for Enterobacter infections.
Beta-lactams: Carbapenems are the most reliable beta-lactam drugs for the treatment of severe Enterobacter infections; fourth-generation cephalosporins are a distant second choice
Aminoglycosides: Aminoglycoside resistance is relatively common and varies widely among centers
Fluoroquinolones: Resistance to fluoroquinolones is relatively rare but may be high in some parts of the world
Trimethoprim-sulfamethoxazole (TMP-SMZ): Resistance to TMP-SMZ is more common
and yes infectious disease specialist can help you in this regard better and referral is pretty much appropriate.
i hope it helps. take good care of your wound and yourself and dont forget to close the discussion please.
Regards
Khan
needs management and referral
Detailed Answer:
thank you for asking
Enterobacter infections can include bacteremia, lower respiratory tract infections, skin and soft-tissue infections, urinary tract infections (UTIs), endocarditis, intra-abdominal infections, septic arthritis, osteomyelitis, CNS infections, and ophthalmic infections. Enterobacter infections can necessitate prolonged hospitalization, multiple and varied imaging studies and laboratory tests, various surgical and nonsurgical procedures, and powerful and expensive antimicrobial agents.
they are a bit of a challenge and not easy to respond to.
the management of the enterobacter cloacae is with antibiotics and wound care.
following are the list of antibiotics advised and recommended for Enterobacter infections.
Beta-lactams: Carbapenems are the most reliable beta-lactam drugs for the treatment of severe Enterobacter infections; fourth-generation cephalosporins are a distant second choice
Aminoglycosides: Aminoglycoside resistance is relatively common and varies widely among centers
Fluoroquinolones: Resistance to fluoroquinolones is relatively rare but may be high in some parts of the world
Trimethoprim-sulfamethoxazole (TMP-SMZ): Resistance to TMP-SMZ is more common
and yes infectious disease specialist can help you in this regard better and referral is pretty much appropriate.
i hope it helps. take good care of your wound and yourself and dont forget to close the discussion please.
Regards
Khan
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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