ASHP 2019 News Network: Challenges Behind Treating ABSSI


Segment Description: Krutika N. Mediwala, PharmD, BCPS, BCIDP, assistant professor, College of Pharmacy, Medical University of South Carolina, discusses the challenges behind treating ABSSSI including source control and readmissions.

Interview transcript (modified slightly for readability):

Acute bacterial skin and skin structure infections or I will just shorten it to ABSSSI as we like to lovingly call them. They can be quite notorious to treat just because by definition-so those were reclassified a little while ago- but by definition, they're usually comprised of cellulitis or some other major abscesses and then also have a measurement of 75 millimeters2. So it is a guidance but it is when you think of it it's very abstract when you're trying to figure out how your patient meets those criteria with that. So it is very difficult to figure out the scope of cellulitis without, trying to look at how much is spread and everything else. The other thing that we love in ID [infectious diseases] is source control. So not having a particular source that I can evacuate like an abscess or something like that. So it's very elusive when you have cellulitis because we don't necessarily have a source that I could point to. And so that can sometimes be difficult to treat.

A lot of the times the patients that I see come back on because they're prescribed oral antibiotics for a skin and skin structure, infection, but they end up coming back and needing to be readmitted in the inpatient setting for IV antibiotics. And I often wonder if maybe it's not the actual antibiotics failing because that's what they're classified as. It might be time that we, you know, we came out with a new guidance by the FDA, but maybe time that we restructure some of the ways we have the algorithm of treatment for these patients. So maybe identifying some patients that would qualify for IV treatment up front, and maybe it's 1 dose, or maybe it's more than a couple of doses, and then we can prescribe them oral antibiotics to finish the treatment versus giving them an oral antibiotic. And maybe they didn't, they needed a little bit more help than that. And then they get readmitted. The hospital gets docked. And then as well as the patient care, we run out of a little bit of options that we have.

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