Reference no: EM133398039

Jimmie Chipwood is a 19-year-old college student who presents to the ED with a new-onset "boil" on his right buttock. He noticed some pain and irritation in the right buttock area over the past week but thought it was due to having slid into second base during a baseball game. The pain gradually increased over the next few days, and he went to the student health center, where they cleaned the wound and gave him a prescription for clindamycin 300 mg QID for 7 days. They recommended he try to keep the area covered until the antibiotic began to work. Today (7 days later), Jimmie returned to the student health center for further evaluation and was referred to the ED for further care for his continued SSTI. At the ED, Jimmie says the area on his buttock is worse, and he cannot sit down for class. He reports only partial adherence to the clindamycin regimen because he often forgets to take it and says it makes him nauseated.

• PMH - Noncontributory
• Surgical History - Appendectomy 4 years ago, Repair of left ACL tear 2 years ago
• SH - Denies any EToH or illicit drug use.
• Meds - Clindamycin 300 mg PO QID × 7 days (prescribed at student health center visit 1 week ago; the patient did not complete the full course).
• Allergies - Penicillin (hives as a child)
• Physical Examination
  • WDWN Caucasian man in no acute distress, but with noticeable pain when he walks and tries to sit
  • BP 129/74, P 81, RR 16, T 37.5°C; Wt 77.5 kg, Ht 6′0″
  • Lateral right gluteal area: red, erythematous, warm, and tender to touch; a localized fluid collection that appears fluctuant, consistent with a carbuncle and surrounding erythema
  • PERRLA; EOMI, oropharynx clear
  • Abdomen Soft, NT/ND; (+) BS
  • Large 2 cm × 4 cm red swollen area over the lateral right buttock, with a localized fluid collection and surrounding erythema

Imaging Studies

Negative for deep tissue involvement; localized area of inflammation and fluid consistent with an abscess.

1. What subjective and objective clinical data are consistent with the diagnosis of an SSTI?
2. What additional information is needed to fully assess this patient's SSTI?
3. Assess the severity (mild, moderate, or severe) of this patient's SSTI based on the subjective and objective information available.
4. make  a list of the patient's drug therapy problems and prioritize them. Include an assessment of medication appropriateness, effectiveness, safety, and patient adherence.
5. What are the goals of pharmacotherapy in this case?
6. What nondrug therapies might be useful for this patient?
7. What feasible pharmacotherapeutic alternatives are available for treating his SSTI?
8. make an individualized, patient-centered, team-based care plan to optimize medication therapy for this patient's drug therapy problems. Include specific drugs, dosage forms, doses, schedules, and durations of therapy.