Originally Posted by
Sensei
Overall, that antibiotic regimen is fairly typical except for the nafcillin which has fallen out of favor due to MRSA. The real question I have is when did you have the first aspiration performed? That is the definitive treatment. Unfortunately, I see far too many people with abscesses and septic bursitis who come to me worsening on antibiotics. That is because the primary treatment of these conditions is adequate drainage (via generous incision for abscesses or serial aspiration for bursitis). No antibiotic, including Zyvox, would be effective without drainage.
To put things in perspective, anyone who comes to me with a red, swollen joint after trauma is going to get a needle one way or the other on the first visit. The definitive test for all bad joint infections mandates a fluid sample. I may put an ultrasound probe over the bursa to look for a drainable fluid collection in cases such as yours that are classic due the the prominent swelling over the bursa. However, if there is no fluid in the bursa, I'm going after the more serious condition which is pus in the actual joint - septic arthritis. Any bacteria in the actual joint is BAAAD juju and generally gets washed out in the OR.
The bottom line is that non-surgeons need to get over their own fear of needles and knives so that patients such as you do not suffer a delay in definitive therapy.