Telephone call with the on call microbiologist regarding joe diamond 557847 hello hi there my name is rob I'm 1 of the medical regs here at torbay so I'm sorry to disturb you no worries I was hoping for a bit of advice about a gentleman with an infected leg ulcer who has a methicillin sensitive staphylococcus aureus but has multiple drug allergies and he's got some previous microbiology I was just hoping for some advice with it is that okay sure yeah yeah yeah of course of course yeah yeah would you like would you like a hospital number or anything like that I'm not in the office I will be able to check on the results but if you tell me the story of course this is so mister joe diamond is a 34 year old man but with significant comorbidity related to poorly controlled type 1 diabetes so he's got autonomic and sensory neuropathy retinopathy nephropathy which is called ckd3 got bilateral charcot foot and a chronic right metatarsal head ulcer and he's had an admissions over the in last year in the middle of last year with infections and cellulitis in this and it looks like there was a concern about cellulitis in december because his gp sent some further swabs from his wound and in terms of the clinical picture his crp is what is it 343 from 6 before and his creatinine's 286 he's got an aki stage 2 with this his lactate's okay and clinically he's got a very his entire right leg is cellulitic swollen up to the groin looking at his antibiotics so he looking at his previous swab so he had a swab on the december 24 which had a light growth of staphylococcus aureus that was resistant to clarithromycin clindamycin doxycycline and penicillin but sensitive to trimethoprim linezolid and flucloxacillin right the complicating factor he's allergic to what is he allergic to clindamycin so we couldn't use we couldn't use that he's illicit and he's allergic to trimethoprim and allergic to penicillins as well okay so we couldn't use fluclox because of that we could use linezolid but there was and then looking at the microbiology review stuff I can see that on the 20 fourth of the twelfth someone not sure who it says g discuss with gp mssa from right leg wound swab consider oral cathalexin - linezolid with usual lookup for interactions contraindications if no improvement and it looks like he was discussed at in january when he was admitted with the same thing right where he has a where he had iv kef triexone with a challenge dose of 2 g then 4 g once a day for 5 to 7 days under matt and it looks like he tolerated the kef triexone okay and then they switched him to and then they switched him to oral kef with with fucidic acid after that so I guess I'm just should I give him another round of kef triaxone is that the right thing given these sensitivities that we see or is or not yeah I mean if he's just as I'm as you say then yeah that's fine you can start him on ceftriaxone perhaps you have to go over the slightly higher dose depending on his weight how big is he he's a big boy he's over 150 kilos bmi's 4 too far 54 I should say 54 yeah okay so go maybe from 3 g once daily of gefraxin thank you and keep him on gefraxin for now and his renal function you were saying is his creatinine is 2 86 egfr 24 okay that's fine leave him for now start him if on he's hemodynamically stable carry on on the once daily gfr and then perhaps if not improving over the weekend then give me a ring back and we can really discuss that's really helpful so 2 g of keflex and iv 3 g I should say and of keflex and then we'll yeah we'll carry on over the weekend thank you ever so much really appreciate your thanks have a nice weekend bye bye bye bye bye