6. Bệnh nhân loét bàn chân do Đái Tháo Đường? Bác sĩ dùng Cephalosporine thế hệ 4 đúng hay sai?
theo Washington 33rd:
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Mild to moderate cellulitis. Rest, elevation of the affected foot and relief of pressure are essential components of treatment and should be initiated at first presentation. In localized cellulitis and new ulcers, Staphylococcus aureus and streptococci are the most frequent pathogens. Therapy with oral dicloxacillin,
first-generation cephalosporin, amoxicillin/clavulanate, or clindamycin is recommended. IV antibiotics may be necessary due if the cellulitis does not respond immediately to oral antibiotics.
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Moderate to severe cellulitis. This type of involvement requires IV therapy and admission to the hospital. Consultation for debridement and aerobic and anaerobic cultures are necessary when necrotic tissue is present. IV oxacillin/nafcillin, a
first-generation IV cephalosporin, ampicillin/sulbactam, clindamycin, and vancomycin are options for therapy. Antibiotic coverage should subsequently be tailored according to the clinical response of the patient, culture results, and sensitivity testing.
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Moderate to severe cellulitis with ischemia or significant local necrosis. It is important to determine the presence of bone involvement and PVD since failure to diagnose osteomyelitis and ischemia often results in failure of wound healing.
+ Bone involvement is present if bone is seen at the base of the ulcer or is easily detected by gentle probing with a blunt sterile probe. Radiographs are not very sensitive for diagnosis and leukocyte scanning or magnetic resonance imaging offers better specificity.
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+ Presence of PVD is suspected by the absence of pedal pulses or decreased capillary filling.
+ IV antibiotics, bed rest, surgical debridement, culture obtained from the base of the ulcer, and bone culture help direct antibiotic therapy.
+ Ampicillin/sulbactam and ticarcillin/clavulanate are first-line agents; piperacillin/tazobactam, clindamycin plus ciprofloxacin, ceftazidime,
cefepime(cephalospororin thế hệ 4), cefotaxime, or ceftriaxone plus metronidazole are good alternatives for initial therapy.
+ In the presence of osteomyelitis, 6 to 12 weeks of IV antibiotic therapy is recommended. Ulcers with localized or generalized gangrene require surgical amputation, often limited to a toe or metarsal head
