Two months ago, a patient with controlled type 2 diabetes developed cellulitis, with two small ulcers on her left lower leg. Since then, she has been on a 10-day course of cephalexin (Keflex) and a seven-day course of ciprofloxacin (Cipro). Her symptoms have improved but not totally resolved. The overall color of her leg and foot is good, and her pedal edema is almost gone. Pedal pulses are good bilaterally, and pain is minimal. Should I refer her or treat her with another antibiotic?
—Jean Skelton, CRNP, Salisbury, Md.
Other therapies, such as dressings, elevation/rest, and control of any edema, are not mentioned. How well controlled is the patient’s diabetes? If a recent glycosylated hemoglobin is <7% and her BP and edema are controlled, appropriate dressings and monitoring should suffice. If any of the complications mentioned persist, a referral would be appropriate.
—Sherril Sego, MSN, FNP (101-21)