首页> 外文期刊>The annals of pharmacotherapy >Treatment of Eikenella corrodens and Actinomyces odontolyticus foot abscess in a penicillin-allergic patient.
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Treatment of Eikenella corrodens and Actinomyces odontolyticus foot abscess in a penicillin-allergic patient.

机译:青霉素过敏患者的艾肯氏菌腐蚀和牙本质放线菌足脓肿的治疗。

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OBJECTIVE: To report a case of Eikenella corrodens and Actinomyces odontolyticus foot abscess secondary to a toothpick puncture in a penicillin-allergic patient that was successfully treated with a long-term course of doxycycline. CASE SUMMARY: A 39-year-old woman with diabetes mellitus type 2 and hyperlipidemia presented with difficulty ambulating as well as pain and swelling of her right foot. Prior to presentation, she sustained a toothpick puncture to her right foot; she removed the toothpick intact and did not know whether it had been used. Due to a penicillin allergy, she began treatment with levofloxacin, which was changed to clindamycin one day later. The patient was diagnosed with right Achilles tendonitis/cellulitis and was discharged on a one-week course of clindamycin. Twenty-five days later she was readmitted, complaining of pain and swelling in the same area, which this time presented as an abscess. Upon this admission, vancomycin and levofloxacin were initiated and incision and drainage (I & D) was performed. Cultures and sensitivities from I & D were significant for E. corrodens and A. odontolyticus, and treatment was changed to intravenous doxycycline 100 mg every 12 hours for 10 weeks. Oral doxycycline 100 mg every 12 hours was then used for 3 months, and treatment was successful. DISCUSSION: E. corrodens and A. odontolyticus are 2 slow-growing organisms that are part of the normal oropharyngeal flora. Extraoral infections due to either of these organisms may be difficult to treat and might need lengthier treatments than are necessary for most infections. First-line treatment for such infections is penicillins and cephalosporins; however, in a patient with penicillin allergy, treatment options become limited, as there is potential cross-reactivity with other agents. CONCLUSIONS: Patients with infections secondary to E. corrodens and/or A. odontolyticus in whom penicillin allergy is a concern can be treated effectively with doxycycline.
机译:目的:报告一例青霉素过敏患者的牙签穿刺继发性艾肯氏杆菌和牙本质放线放线杆菌脚脓肿的病例,该患者经长期多西环素治疗成功。病例摘要:一名39岁的2型糖尿病和高脂血症的妇女表现出活动困难,右脚疼痛和肿胀。出诊前,她的右脚扎了一根牙签。她完整地取出了牙签,不知道是否已使用过。由于青霉素过敏,她开始用左氧氟沙星治疗,一天后改用克林霉素。患者被诊断患有右跟腱炎/蜂窝组织炎,并在克林霉素治疗一周后出院。 25天后,她再次入院,抱怨同一部位疼痛和肿胀,这次表现为脓肿。入院后,开始使用万古霉素和左氧氟沙星并进行切开引流(I&D)。来自I&D的培养物和敏感性对大肠杆菌和溶齿曲霉具有重要意义,并且将治疗改为每12小时静脉注射强力霉素100 mg,持续10周。然后每12小时口服100 mg强力霉素3个月,治疗成功。讨论:大肠杆菌和溶齿曲霉是两种缓慢生长的生物,属于正常的口咽菌群。由这些生物中的任何一种引起的口腔外感染可能难以治疗,并且可能需要比大多数感染所需的更长的治疗时间。这类感染的一线治疗是青霉素和头孢菌素。然而,在青霉素过敏的患者中,治疗选择受到限制,因为它可能与其他药物发生交叉反应。结论:多西环素可有效治疗对青霉素过敏有疑虑的继发于大肠杆菌和/或牙本质曲霉的继发感染的患者。

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