Attached above is (hopefully) the article from last month's NEJM on CA-MRSA. I encourage you all to review this article, and if you cannot, I will gladly send you the email link that lasts 30 days. A few summary points:
- The article readily admits that much is based on clinical experience, not evidence based medicine.
- Like most CA-MRSA articles the article takes the "ivory tower" suggestion of solely relying on incision and drainage without antibiotics, but then lists the legion amount of caveats that indeed need antibiotics: multiple sites of infection, "rapid disease progression", associated cellulitis, signs of systemic illness, very young or advanced age, or face/hand/ genitalia abscesses. So, in the real lawyer infected world this means: "Everyone gets antibiotics." Note any first year lawyer can take the obtuse term "rapid disease progression" and contort it to a jury with a second grade health literacy level. ( FYI- national average is 4th grade.)
- I found most useful the evolving prevention tips. I have long been a fan of Hibiclens, and the article had some actual tips.
HIBICLENS/Prevention Tips
- Apply to all body parts from the neck down (stings the eyes,nose mouth), then rinse. Do this for 5 days.
- Remember that after you apply the Hibiclens in the shower and rinse, do not remove the protective layer by then applying soap, shampoo, etc. One female patient told me "So, you mean the Hibiclens is like conditioner...you apply it last and try to keep some in." Being bald, I told her it made sense in theory:).
- Also consider 2% mupirocin to the nares with a sterile cotton swab bid for 5 days.
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