Match each clinical presentation of a localized skin and soft tissue infection with the most appropriate empiric oral antimicrobial therapy.
- A 45-year-old woman presents with a rapidly expanding, sharply demarcated, brilliantly erythematous, and raised plaque on her right cheek accompanied by sudden-onset fever.Oral penicillin V
- A 28-year-old man presents with a 4-centimeter, fluctuant, exquisitely tender erythematous nodule on his posterior thigh with surrounding induration.Oral trimethoprim-sulfamethoxazole
- A 62-year-old man presents with poorly demarcated, flat, spreading erythema and warmth over his left lower extremity without any purulent drainage or fluctuance.Oral cephalexin
- A 19-year-old male athlete presents with a deep, erythematous, and tender puncture wound on the plantar aspect of his foot sustained while wearing rubber-soled athletic shoes.Oral ciprofloxacin
Answer
Erysipelas matches with oral penicillin V; purulent abscesses match with oral trimethoprim-sulfamethoxazole; non-purulent cellulitis matches with oral cephalexin; and sneaker-associated puncture wounds match with oral ciprofloxacin.
Empiric antimicrobial stewardship requires matching the clinical phenotype to the most likely pathogen profile. Group A Strep (erysipelas) requires penicillin. Mixed Strep/MSSA (non-purulent cellulitis) requires cephalexin. MRSA (purulent abscess) requires trimethoprim-sulfamethoxazole. Pseudomonas (sneaker puncture) requires ciprofloxacin.
Step-by-Step Solution
Key Concept
Selection of empiric oral antibiotics for skin and soft tissue infections is strictly guided by the clinical phenotype (purulent vs. non-purulent) and specific environmental exposures.