

IVF: D5 IMB 500mL to run at 12-13 gtts/min
Request for:
◦ CBC with platelet
◦ Gram stain of wound discharge
◦ Culture and sensitivity of wound discharge

Medications:
◦ Clindamycin 150mg/slow IV infusion (32.1mg/kg/day)
over 30 mins. now then every 8 hrs. ANST
◦ Amikacin 100mg/slow IV push over (21.4mg/kg/day) 30
mins. every 8 hrs.
◦ Paracetamol 250mg/5mL, 4 mL every 4 hours for Temp.
> 38.5°C or for pain (14 mg/kg/dose )
◦ Refer to Pediatric Surgery for further evaluation and
management

Incision and Drainage of Abscess
◦ 20cc purulent discharge
◦ Specimen sent for GS/CS

For daily COD
Complete Blood Count
Hgb
110
RBC
4.11
Hct
0.33
MCV
79.90
MCH
26.80
MCHC
33.50
RDW
14.00
MPV
6.20
Platelet
281
WBC
12.10
Neutrophils
0.54
Lymphocytes
0.41
Monocytes
0.03
Eosinophils
0.02
Microbiology Examination
Gram (+) Cocci in Pairs
Few
Pus Cells
++++

D1-2
◦ Clindamycin 150mg/slow IV infusion
(32.1mg/kg/day) over 30 mins. now then every 8
hrs. ANST
◦ Amikacin 100mg/slow IV push over
(21.4mg/kg/day) 30 mins. every 8 hrs.




Decreased to D5 IMB 500mL to run at 9-10
gtts/min
Patient was transferred to malward
IVF to consume
Increase oral fluid intake
Culture and Sensitivity: Wound Discharge
Staphylococcus aureus
Heavy Growth
*MRSA
Positive
Sensitive to:
Azithromycin
Chloramphenicol
Clindamycin
Erythromycin
Gentamycin
Co-trimoxazole
Vancomycin
Resistant to:
Penicillin

D5-6
◦ Clindamycin 150mg/slow IV infusion
(32.1mg/kg/day) over 30 mins. now then every 8
hrs. ANST
◦ Amikacin 100mg/slow IV push over
(21.4mg/kg/day) 30 mins. every 8 hrs.

0.65% NaCl Nasal drops 2-3 gtts/nostril then
suction Q6

Day 14

Disharged
◦ Clindamycin 150mg/slow IV infusion (32.1mg/kg/day)
over 30 mins. now then every 8 hrs. ANST
◦ Amikacin 100mg/slow IV push over (21.4mg/kg/day) 30
mins. every 8 hrs.
◦ Final Diagnosis: Abscess secondary to MRSA
◦ Take Home Medications:
 Co-trimoxazole 400mg 180mg/5mL, 4mL Q12 to complete
for 2 weeks
 Mupirocin ointment, apply on affected area TID
◦ Anticipatory Guidance
◦ Immunization update
◦ For follow up at OPD on Oct 10, 2010