134.3 🩺 內科專科考前版

134.3.0.1 1️⃣ 22E 更新

• MRSA prevalence community 5-30% (region-dependent) → empirical TMP-SMX/Doxy growing
• Linezolid alternative to vancomycin (PO bioavailability 100%)
• Tedizolid (newer oxazolidinone): once daily, fewer toxicities
• Omadacycline, Lefamulin: novel agents for MRSA / drug-resistant SSTI
• Dalbavancin / Oritavancin: long-acting glycopeptide single-dose IV — outpatient SSTI

134.3.0.2 2️⃣ Recurrent SSTI

• MRSA decolonization: nasal mupirocin 2% × 5 days (reduce nasal carriage), chlorhexidine body washes 5-10 d
• 家庭成員同步 decolonize 較有效
• Improve hygiene, no sharing towels/razor

134.3.0.3 3️⃣ Special Situations

134.3.0.3.1 IVDU SSTI

• S. aureus (incl MRSA) > 50%
• Polymicrobial possible (skin flora + IVDU technique)
• Vanco + pip-tazo for severe; Vanco alone if local
• Workup: blood cultures, echo (rule out IE), HIV/HBV/HCV

134.3.0.3.2 DM Foot

• Mild: PO antibiotic + offloading + glycemic control
• Mod-severe: IV pip-tazo (cover Pseudomonas, anaerobes) ± vanco (MRSA)
• Severe with osteomyelitis (probe-to-bone): MRI + debridement + 6 wk IV antibiotic

134.3.0.3.3 Post-mammalian bite

• Cat / Human bite: Pasteurella multocida (cat); Eikenella corrodens (human)
• Empirical: amoxicillin-clavulanate
• 不能 PO: ampicillin-sulbactam IV
• Tetanus + rabies prophylaxis 評估

134.3.0.4 4️⃣ 台灣 context

• Vibrio vulnificus 在沿海/夏季 + 肝病人 (cirrhosis, hemochromatosis): 高 mortality, 緊急 doxy+ceftri+ debride
• 海水/海鮮接觸史 + cellulitis 急速 worsening → Vibrio empirical
• 健保 vancomycin / linezolid / daptomycin restrictions: ID consult required

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