Chapter 66 Skin and Bone & Joints Infections Sample Questions
1. PH, a 35 year old patient who is limping presents to his family physician with symptoms that include pain, redness and swelling over his left foot accompanied by fever. T (oral): 38.8°C. Patient indicates that he’s had these symptoms for over a week now. The doctor learns that PH underwent a recent surgery of the foot affected. The wound seemed healing following his discharge but later on, the symptoms PH complaining now started to appear and bother him. The doctor notes warmth and erythema over the area and skin feels tender. The doctor orders CBC for differential along with ESR and CRP measurement and culture and sensitivity and x-ray of the affected leg. He gives a diagnosis of osteomyelitis from the definitive symptoms and results of the investigations done. On patient’s profile, doctor writes his treatment plan for PH as follows:
Vancomycin 1 g Q12H IV
Regarding PH’s medication, which of the following is true?
- A. Vancomycin is the best if given orally.
- B. Oral vancomycin is not absorbed.
- C. It is not the drug of choice against MRSA osteomyelitis.
- D. None of the above.
Ans:
B
Tips: Oral vancomycin is only used for P. colitis treatment. Otherwise, in all other infections, Vancomycin is used injection.
Absorption: Oral vancomycin is poorly absorbed from the GI tract. Intramuscular absorption is erratic. Intraperitoneal administration results in approximately 38% systemic absorption.
Distribution: The volume of distribution of vancomycin is 0.4–1 L/kg and the α-distribution phase ranges from 30 minutes to 1 hour. Vancomycin is 50–55% protein bound. The drug distributes widely into body tissue and fluids including pericardial, pleural, ascitic and synovial fluid. Low and variable vancomycin concentrations are obtained in CSF; however, inflammation increases CSF penetration and concentrations may be higher here in patients with meningitis. Penetration into skin and lung tissue has been found to be variable
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