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When a patient presents with a soft-tissue infection and claims it is due to a spider bite, perhaps you don't want to go there. "Spiders are getting a bad rap. Get a culture because what you are seeing is probably community-acquired MRSA (methicillin-resistant staphylococcus aureus)," says Tom Frank, Pharm.D., B.C.P.S., an associate professor of pharmacy practice and assistant professor of family and community medicine at the University of Arkansas for Medical Sciences, Jonesboro, Ark.
Frank, who conducted the Dialogue session "Antimicrobial Therapy: New Challenges, Few Tools" at the Assembly, says that "77 percent of patients presenting with soft-tissue infections are showing up with MRSA on culture." Most of these patients attribute the infection to spider bites, he says. This observation was confirmed during the discussion when several physicians noted that they, too, were seeing a surge in spider bite complaints.
One unique aspect of these "spider bites" is that "the wound abscesses and needs to be drained," Frank says. In a typical case report, a woman presented with progressive swelling of an index finger. She was admitted to the hospital and treated with IV cefazolin. When the finger was incised, a deep abscess was drained, but two days later she required a second surgery because drainage persisted. A culture obtained at the original surgery grew MRSA resistant to erythromycin. She was treated with IV vancomycin followed by oral trimethoprim-sulfamethoxazole and recovered.
Since resistance is a significant problem, Frank advises "holding off on vancomycin treatment. Instead, I am recommending some old weapons from the arsenal: bactrim, clindamycin and doxycycline as a simple first step in treating these soft-tissue infections." He cautions, however, that these agents may take three to four weeks.
Frank favors a fast, aggressive treatment for strep: "I say be aggressive, be short and be gone. In the majority of patients, if there is no improvement with the initial dose of amoxicillin or augmentin at day three, increase the dose."
Finally, Frank says that "this year when we've just found out that we have an insufficient supply of influenza vaccine, your mother's advice is more important than ever -- wash your hands, wash your hands."
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Copyright © 2004 by American Academy of Family Physicians.