From the Guidelines
The patient should be treated with cephalexin 500mg orally four times daily for 7-10 days, as this first-generation cephalosporin provides good coverage against common skin pathogens including Staphylococcus aureus and Streptococcus species, as recommended by the 2014 update by the Infectious Diseases Society of America 1. The presentation of this 47-year-old male with progressive swelling from a bug bite near his left ear over three days, now with a scratchy throat but no systemic symptoms, suggests cellulitis, likely from an infected insect bite. Laboratory findings show mild monocytosis and slightly elevated liver enzymes, which may be related to the inflammatory process. CT imaging reveals mild periorbital edema consistent with inflammation but no abscess or fractures.
- The patient's symptoms and laboratory findings are consistent with a diagnosis of cellulitis, which is typically caused by bacterial infection.
- The use of cephalexin is supported by the guidelines, which recommend first-generation cephalosporins for the treatment of uncomplicated skin and soft tissue infections 1.
- The patient should be instructed to complete the full course of antibiotics even if symptoms improve quickly, and to return immediately if he develops fever, increased swelling, red streaking from the site, or worsening throat symptoms.
- Warm compresses to the affected area 3-4 times daily can help reduce inflammation, and follow-up evaluation is recommended in 48-72 hours to ensure improvement.
- The mild liver function abnormalities should be rechecked after treatment completion to ensure they are not a sign of a more serious condition. The most recent and highest quality study, the 2014 update by the Infectious Diseases Society of America 1, provides the best guidance for the treatment of this patient's condition.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Patient Presentation
- A 47-year-old male presents to the ED with a bug bite next to his left ear, which has become increasingly swollen over the past 2 days
- The patient denies fever, chills, shortness of breath (SOB), and fatigue
- He reports developing a scratchy throat since the morning of presentation
- Laboratory results:
- CBC: monocytes absolutely 1.1, otherwise unremarkable
- CMP: 0.70, ALT-SGPT 59, otherwise unremarkable
- CT maxillofacial: mild peri-orbital edema, possible inflammatory process, no evidence of abscess, sinuses well-aerated, no evidence of fracture
Treatment Considerations
- The patient's symptoms and laboratory results do not clearly indicate a bacterial infection requiring antibiotic treatment 2, 3, 4
- However, the development of a scratchy throat may suggest the possibility of pharyngitis, which can be caused by viral or bacterial infections 2, 4
- The use of antibiotics such as cephalexin may be considered in cases of bacterial pharyngitis, but the decision to prescribe antibiotics should be based on careful evaluation of the patient's symptoms and laboratory results 5, 6
SOAP Note
- S: 47-year-old male presents with a bug bite next to his left ear, which has become increasingly swollen over the past 2 days, and a scratchy throat
- O: Laboratory results: CBC, CMP, CT maxillofacial
- A: Possible inflammatory process, consideration of pharyngitis
- P: Consideration of antibiotic treatment, such as cephalexin, but decision to prescribe should be based on careful evaluation of patient's symptoms and laboratory results 2, 5, 3, 6, 4
Antibiotic Treatment
- Cephalexin may be considered as a treatment option for bacterial pharyngitis, but the dosage and duration of treatment should be determined based on the patient's specific condition and laboratory results 5, 6
- The typical dosage of cephalexin for adults is 250-500 mg every 6 hours, but this may vary depending on the specific condition being treated 5