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Let’s consider this case again

Reconsidering case 1
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© BSAC

A 27-year-old patient is admitted to hospital with general malaise and uncontrollable shivering, and a painful, red, warm and swollen foot following a minor injury two days prior (no foreign body or osteomyelitis on radiography).

The patient has a temperature of 38.7°C, pulse 110/minute, BP 120/80, RR 18/minute and oxygen saturations of 97% on air.

The patient’s WCC is 14 and CRP 179.

The patient is not confused, has no comorbidity, does not take any regular medications and has no allergies.

The patient is commenced on intravenous Flucloxacillin.

One day later, blood cultures are negative and the patient has remained afebrile and is feeling much better.

The patient’s pulse is now 90/minute, but the foot looks much the same and remains painful.

The patient is keen to go home and is transferred to the OPAT service for treatment with a once daily antimicrobial with appropriate anti-Gram-positive activity.

On day 5 you are asked to review the patient. The patient’s observations are all satisfactory. The WCC is now 8 (was 14) and CRP 26 (was 179). The patient’s foot looks much better. In fact, the patient tells you it is almost back to normal. Examination is unremarkable except for some mild swelling and a hint of erythema. The patient has had 5 full days of IV antibiotic therapy now.

Discuss with your fellow learners how you would manage this case now and what factors you would consider in doing so.

© BSAC
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Intravenous to Oral Switch: Within Outpatient Parenteral Antibiotic Therapy (IVOST)

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