Why was the patient put on IV vancomycin for a penicillin-sensitive strep (“Botched cryotherapy procedure leads to painful bullous lesion,” October 2010)? Also, why was the patient taken to the operating room so soon? The clinicians were given less than 24 hours to assess the activity of the antibiotic. It seems like an aggressive approach to a problem that could have been handled in a less invasive manner. — MARY PROCTOR, PA-C, Williamsburg, Mich.
When the patient was admitted and started on the IV vancomycin, the culture results were not yet finalized. There is a very high rate of community-associated, methicillin-resistant Staphylococcus aureus in the military population, and we treat for that presumptively. After the culture results came back, the patient was showing clinical improvement, and the supervising physician elected to keep her on the vancomycin until discharged on oral amoxicillin. As far as her treatment, she was showing much more discomfort with passive motion of the fingers and wrist on Day 2. Having seen the less-than-desirable outcome of waiting on a hand infection with signs of impending flexor tenosynovitis, we elected to perform the incision and drainage. — Jeffrey L. Spivey, MPAS, PA-C (145-17)