COURSE IN THE WARD

IVF: D5 IMB 500mL to run at 12-13 gtts/min Request for:

◦ CBC with platelet◦ Gram stain of wound discharge◦ Culture and sensitivity of wound discharge

Medications:◦ Clindamycin 150mg/slow IV infusion (32.1mg/kg/day)

over 30 mins. now then every 8 hrs. ANST◦ Amikacin 100mg/slow IV push over (21.4mg/kg/day) 30

mins. every 8 hrs.◦ Paracetamol 250mg/5mL, 4 mL every 4 hours for Temp.

> 38.5°C or for pain (14 mg/kg/dose )◦ Refer to Pediatric Surgery for further evaluation and

management

1ST Hospital Day

Incision and Drainage of Abscess◦ 20cc purulent discharge◦ Specimen sent for GS/CS

For daily COD

1st Hospital Day

Complete Blood Count

Hgb 110

RBC 4.11

Hct 0.33

MCV 79.90

MCH 26.80

MCHC 33.50

RDW 14.00

MPV 6.20

Platelet 281

WBC 12.10

Neutrophils 0.54

Lymphocytes 0.41

Monocytes 0.03

Eosinophils 0.02

Microbiology Examination

Gram (+) Cocci in Pairs Few

Pus Cells ++++

D1-2 ◦ Clindamycin 150mg/slow IV infusion

(32.1mg/kg/day) over 30 mins. now then every 8 hrs. ANST

◦ Amikacin 100mg/slow IV push over (21.4mg/kg/day) 30 mins. every 8 hrs.

Decreased to D5 IMB 500mL to run at 9-10 gtts/min

Patient was transferred to malward IVF to consume Increase oral fluid intake

2nd Hospital Day

Culture and Sensitivity: Wound Discharge

Staphylococcus aureus Heavy Growth

*MRSA Positive

Sensitive to:

Azithromycin Chloramphenicol Clindamycin

Erythromycin Gentamycin Co-trimoxazole

Vancomycin

Resistant to:

Penicillin

D5-6◦ Clindamycin 150mg/slow IV infusion

(32.1mg/kg/day) over 30 mins. now then every 8 hrs. ANST

◦ Amikacin 100mg/slow IV push over (21.4mg/kg/day) 30 mins. every 8 hrs.

0.65% NaCl Nasal drops 2-3 gtts/nostril then suction Q6

5th Hospital Day

Day 14◦ Clindamycin 150mg/slow IV infusion (32.1mg/kg/day) over

30 mins. now then every 8 hrs. ANST◦ Amikacin 100mg/slow IV push over (21.4mg/kg/day) 30

mins. every 8 hrs. Disharged

◦ Final Diagnosis: Abscess secondary to MRSA ◦ Take Home Medications:

Co-trimoxazole 400mg 180mg/5mL, 4mL Q12 to complete for 2 weeks

Mupirocin ointment, apply on affected area TID◦ Anticipatory Guidance◦ Immunization update◦ For follow up at OPD on Oct 10, 2010

14th Hospital Day