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Suggest treatment for staph infection on the left thigh

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Posted on Fri, 29 May 2015
Question: Hello. I have a suspected staph infection on my left thigh (towards the front) that I had evaluated at the local Urgent Care due to cellulitis. In addition to the spreading red inflammation, I also had/have a large hard lump/abscess (about the size of a ping pong ball) that is extremely painful. He prescribed Bactrim and a 3 day course of pain medication.
I have been on the antibiotic now for 48+ hours. I see no improvement in the lump, though the redness around it has receded some. HOWEVER, I see and feel what appears to be NEW instances of cellulitis on the right leg. (corresponding to the current abscess.) They are red, raised, itch, and are painful. I am concerned about new abscesses appearing there.
I called the Urgent Care regarding these lack of changes as well as the new developments. They have referred me to the emergency room.
My question is: Have I really given the Bactrim enough time to work? Do I REALLY need to go to the ER? And if I do, what are they most likely going to do for me at the ER?
Thank you. I am really confused, and feel lousy. I feel like I have the flu, but no fever. Chills, yes. But no fever.
Looking forward to your advice.
doctor
Answered by Dr. T Chandrakant (1 hour later)
Brief Answer:
Confirm if abscess - if yes, go for incision- add antibiotic

Detailed Answer:
Hi.
Thanks for your query and an elucidate history.

To recapitulate: Female/39 - taking Minocyclin for Hidradenitis - cellulitis left thigh evaluated at local Urgent Care - extremely painful inflammation with large hard lump - Bactrim and Pain medication for 3 days - for 48 hours now - lump not improved and new development of red, raised, itchy and painful cellulitis on right side - Urgent care referred to Emergency Room - has chills and fluy like symptoms

Your Question:
Enough time for Bactrim to work?
Need to go to ER
What will they do in ER ?

My thoughts:
You have developed abscess in spite you are already under Minocyclin and now on Bactrim.

48 hours is a sufficient time for the proper antibiotics and medicines to work.

Certain reason for no response are:
- Infection is virulent and may need additional antibiotic cover.
- Development of abscess can not allow the antibiotics to work effectively and can give tough time with any antibiotic and may need an incision and drainage.

Hence it is imperative to go to the ER.
The things that may be done at ER depends upon the policy of that particular establishment. It will be difficult for me to pin point what they would do, yet on a broad basis I would do the following:
- Send the sample of blood for culture and sensitivity.
- Ultrasonography or Aspirate to see if an abscess has developed, if yes, needs incision and drainage.
- If no abscess, add on an antibiotic of another group.
- Blood tests to see for sugar, urea, creatinine

Please do not be confused, follow the standard format.

I hope this answers your queries, you get an early and proper diagnosis and treatment.
Please feel free to ask for further relevant queries if you need to or if you feel that there is a gap-of-communication.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (12 minutes later)
Oh my goodness! I really don't want them to drain this. I have had lancing done previously, twice while pregnant in hospitals, and once at an urgent care facility. In all 3 cases, no pain medication was used. It was excruciating. Could they have withheld any analgesics due to pregnancy and the facility not having supplies of such medications? Do you believe; in your professional experience, of course; that the hospital will treat the pain associated not only with the current state of the infection, but also the pain associated with the lancing of the abscess?
I fear the pain the most. Hence my hesitation to go to the ER. I REALLY don't want to go. It already hurts enough as it is.

doctor
Answered by Dr. T Chandrakant (13 minutes later)
Brief Answer:
At least get checked the present status as explained above.

Detailed Answer:
Oh, this is what I was thinking - the bad experience at previous times.
I can certainly understand the pains one goes through if lancing is done without proper anesthesia and you had it.

Pregnancy is not contraindication for good anesthesia as pain can give more complication.(Again a thing of past)

At least get checked if it is developed yet or not, get additional treatment of an additional antibiotic, a good anti-inflammatory and a pain-killer like tramadol and so on.

Pain has to be covered all the time, before during and after surgery.
We prefer lancing only under general anesthesia, this must be totally a painless procedure.

I hope this helps you.
Insist on painless procedures. (if at all needed)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. T Chandrakant

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Suggest treatment for staph infection on the left thigh

Brief Answer: Confirm if abscess - if yes, go for incision- add antibiotic Detailed Answer: Hi. Thanks for your query and an elucidate history. To recapitulate: Female/39 - taking Minocyclin for Hidradenitis - cellulitis left thigh evaluated at local Urgent Care - extremely painful inflammation with large hard lump - Bactrim and Pain medication for 3 days - for 48 hours now - lump not improved and new development of red, raised, itchy and painful cellulitis on right side - Urgent care referred to Emergency Room - has chills and fluy like symptoms Your Question: Enough time for Bactrim to work? Need to go to ER What will they do in ER ? My thoughts: You have developed abscess in spite you are already under Minocyclin and now on Bactrim. 48 hours is a sufficient time for the proper antibiotics and medicines to work. Certain reason for no response are: - Infection is virulent and may need additional antibiotic cover. - Development of abscess can not allow the antibiotics to work effectively and can give tough time with any antibiotic and may need an incision and drainage. Hence it is imperative to go to the ER. The things that may be done at ER depends upon the policy of that particular establishment. It will be difficult for me to pin point what they would do, yet on a broad basis I would do the following: - Send the sample of blood for culture and sensitivity. - Ultrasonography or Aspirate to see if an abscess has developed, if yes, needs incision and drainage. - If no abscess, add on an antibiotic of another group. - Blood tests to see for sugar, urea, creatinine Please do not be confused, follow the standard format. I hope this answers your queries, you get an early and proper diagnosis and treatment. Please feel free to ask for further relevant queries if you need to or if you feel that there is a gap-of-communication.