Infections

Cystitis-this is one of the most common infections we see. It is very common in women due to their anatomy. Men rarely get bladder infections. A 3 day course of antibiotics will cure almost all uncomplicated infections in womem. Septa, amoxicillin, doxycycline, or a cephalosporin are frequently used. The diagnosis is confirmed by a urinalysis, but the symptoms may be enough in some cases.

Bronchitis-the vast majority are due to a viral upper respiratory infection, and need only symptomatic treatment. We often have a chest x-ray done to be sure pneumonia is not present. If the x-ray is clear, cough suppressants(codeine mixtures) will ameliorate the nocturnal cough. Many doctors prescribe antibiotics for bronchitis, but they arerarely necessary. They can be used when you have an unusual bacterial infection-pertussis (whooping cough) or mycoplasma infections, but we rarely see these.

Sinusitis- a cold lasting more than a week is usually a complicating sinus infection. If you treat the nose with decongestants(but OTC Advil Cold & sinus or similiar products), you may be able to promote enough drainage to keep the sinuses from blocking and getting infected. Try this before antibiotics, or before you come in. If your teeth hurt or you have pressure over your upper jaw or upper nasal area, you may need a course of antibiotics. Most sinus infections are self limited.

Pink eye-a viral infection virtually all the time, but very contageous. Wash your hands and do not rub your eyes. We need to make sure you do not have a corneal abrasion, so we stain the cornea first. Antibiotics are often used, but I do not feel they contribute much-the infection will resolve spontaneously.

Infected wounds-we see a lot of wounds-falls, cuts, animal bites, etc.
Cat bites always are treated with amoxicillin or cephalexin antibiotics. Without treatment, most will become infected with pasturella multicida, a relative of the plague bacteria, pasturells pestis.
Dog bites are less of a problem-we do not treat all of them.
Insect bites generally cause a local allergic reaction, not an infection, but we have seen serious infections from insect bites.
Spider bites are an enigma-no one ever sees the spider, so we never what the insect was. The only spider in Orange County of concern is the Black Widow. The Brown Recluse Spider is not within 1000 miles of here-South, Mid-West, and East Coast. The state of Washington has the Hobo Spider.
Paronychia-this is an infection around the nail of a finger or toe. You can try to soak the infected part in salt water, but most need to be drained. It is a localized abscess, and good surgical treatment dictates drainage as the procedure of choice. Antibiotics are occasionally, but not usually needed after drainage.

Influenza-the flu season will start in Dec-Jan. We have had very little flu the past 2 years, but there is no way to predict the incidence this year. Look on the Internet-it shows states affected. We now have a rapid test to diagnose true influenza with a nasal swab. Treatment with antiviral agents is effective and available. We see pneumonia with influenza and do not know if it is viral or bacterial-you cannot tell by x-ray. We would treat these patients with combination therapy-antiviral and antibiotics.
Community acquired pneumonia-most of the time, pneumonia is caused by Streptococcus pneumonia, a bacteria that used to be sensative to tiny amounts of the common antibiotic penicillin. Those days are gone. Today we are finding we need large doses of peniclillin or another appropriate antibiotic. Some are now penicillin resistant;all strains require much larger doses of an antibiotic. We need to treat pneumonia more agressively in seniors with other co-morbid problems like emphysema, heart disease, diabetes, etc. Young people usually do not require strong antibiotics for as long a course, and may not need follow up like seniors do.

Corneal abrasions-this can be a serious infection. CONTACT LENS WEARERS ARE AT RISK. WE STAIN THE cornea and use a slit lamp(the main tool of the ophthalmologist) to get a better look at the ulcer. We use topical antibiotics to the eye for ulcers we feel comfortable in handeling. Severe deep ulcers are referred immediately to one of our local eye doctors.

Shingles-this is a viral infection causedby the chicken pox virus that infected you in your youth and has been dormant in your spinal cord nerve roots all these years. If we make the diagnosis early enough, antiviral agents are helpful, and we use them. If the infection is over 5-6 days, treatment is directed at pain management and weeping skin.

Stys-these red swellings on the lid margins usually respond to warm compresses. Occasionally, antibiotics are employed. Most are low morbidity staph infections.

Skin cysts, abscesses-we ofted see sebaceous cysts on the back that become infection after a long quiescent period. They need to be drained. The cyst has a capsule that must be removed or the cyst will reform in time. We open the cyst and remove as much of the capsule as possible.

Written & edited by Robert E. Dyer, MD**

**This part of our web site on infections was done rapidly to get the site up. As time permits, I will edit the above and add to infections I have omited. I will also expand it with questions from patients, it you contact the site.
Other topics will be added, including:

• Trauma(skin lacerations,ankle sprains, head injuries, rib fractures, etc),
• Pain management-back pain especially
• Systemic/metabolic disorders-hypertension, diabetes, cholesterol control
• Common orthopedic problems seen in the urgent care.
• ENT disorders

More resources on infections:
www.kidshealth.org
www.nlm.nih.gov