Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

294 Cellulitis Cerebrovascular Disease & Stroke

■Diabetic/vascular insufficiency – dicloxacillin, cephalexin or clinda-

mycin; if hospitalized, Unasyn or Zosyn alone or with a fluoroqui-

nolone

■Human bites – Augmentin or, in the penicillin-allergic patient, clin-

damycin plus a fluoroquinolone; hospitalized – Unasyn or Zosyn;

clindamycin plus a fluoroquinolone if penicillin-allergic

■Dog/cat bites – same as human bites

follow-up

■Improvement in 48–72 h expected in uncomplicated cellulitis; if not

improved, consider osteomyelitis, abscess (especially IV drug user),

deep tissue infection or unusual organism

■Bites – assess every 24–48 hours until improvement; Pasteurella

infections slow to resolve (over weeks)

■Diabetes/vascular insufficiency – assess every 48–72 hours; cellulitis

improves in days; ulcer takes weeks to resolve

complications and prognosis

■Chronic recurrent cellulitis a rare complication associated with pre-

disposing conditions (tinea pedis, edema); treat underlying condi-

tion and consider prophylaxis with monthly benzathine penicillin

or daily oral penicillin or macrolide

■Bites – septic arthritis, osteomyelitis, sepsis (seen in asplenia, severe

liver disease) and endocarditis; prophylaxis indicated in high-risk

bites (cat and human bites, bites of the hand) and high-risk patients

(immunosuppressed, asplenic, cirrhosis); Augmentin for 5 days drug

of choice

■Diabetes/vascular insufficiency – localized disease successfully

treated in >90%; invasive disease results in amputation in up to 50%

Cerebrovascular Disease & Stroke........................

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Sudden onset of focal motor or sensory deficit

■Altered consciousness common; coma may occur

■May be headache or seizures

■May be past history of TIA, amaurosis fugax, hypertension, diabetes

or other predisposing disorder