{"id":1087,"date":"2010-09-06T08:09:00","date_gmt":"2010-09-06T12:09:00","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=1087"},"modified":"2015-06-04T15:24:42","modified_gmt":"2015-06-04T19:24:42","slug":"treating-cellulitis-getting-the-answer-wrong-and-right","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/treating-cellulitis-getting-the-answer-wrong-and-right\/2010\/09\/06\/","title":{"rendered":"Treating Cellulitis:  Getting the Answer Wrong and Right"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-1088\" title=\"laborday poster\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2010\/09\/laborday-poster1.jpg\" alt=\"laborday poster\" width=\"243\" height=\"321\" \/>What&#8217;s the <a href=\"http:\/\/blogs.nejm.org\/index.php\/testing-your-testing-skills\/2010\/09\/01\/\" target=\"_blank\">right antibiotic choice for cellulitis<\/a> in the era of community-acquired MRSA?<\/p>\n<p>As astutely pointed out by Anne in her comment, the &#8220;correct&#8221; answer to the recertification question was #4, trimethoprim-sulfamethoxazole, for the following reason:<\/p>\n<blockquote><p>I am not a doctor, I am a test developer. Having exactly zero knowledge about the content here (could be Chinese to me), but based solely on the structural design of multiple-choice items, I would venture to guess that the correct answer (the \u201ckey\u201d in testing parlance) is #4. I say this merely because it is significantly longer than the other three options (the \u201cdistractors\u201d) and therefore leads one to believe that it contains the best information.<\/p><\/blockquote>\n<p>However, what does it mean that the person giving the correct answer isn\u2019t a doctor, and admittedly has &#8220;zero knowledge&#8221; on the subject?<\/p>\n<p>Well, it probably means that the question is flawed &#8212; which is obviously the case, since there&#8217;s no right answer.<\/p>\n<p>Azithromycin is plainly wrong.<\/p>\n<p>You migh choose dicloxacilln or cephalexin, but one over the other? \u00a0And both don\u2019t cover MRSA.<\/p>\n<p>And trimethoprim-sulfamethoxazole doesn&#8217;t cover strep.<\/p>\n<p>Don&#8217;t believe me?\u00a0 Read <a href=\"http:\/\/journals.lww.com\/md-journal\/Abstract\/2010\/07000\/The_Role_of__beta__Hemolytic_Streptococci_in.4.aspx\" target=\"_blank\">this recent paper<\/a> on community acquired &#8220;nonculturable&#8221; cellulitis, which shows that a significant proportion are not surprisingly still due to beta strep, even in the era of community acquired MRSA.<\/p>\n<p>In the real world of treating patients and not answering test questions, what we actually should do in this situation is hardly clear &#8212; diclox or cephalexin first then change if no response? \u00a0TMP-SMX + amox?<\/p>\n<p>I&#8217;d suggest that such ambiguous situations make for exam items that are more maddening than educational.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>What&#8217;s the right antibiotic choice for cellulitis in the era of community-acquired MRSA? As astutely pointed out by Anne in her comment, the &#8220;correct&#8221; answer to the recertification question was #4, trimethoprim-sulfamethoxazole, for the following reason: I am not a doctor, I am a test developer. Having exactly zero knowledge about the content here (could [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5,6,8],"tags":[175,630,786],"class_list":["post-1087","post","type-post","status-publish","format-standard","hentry","category-infectious-diseases","category-medical-education","category-patient-care","tag-cellulitis","tag-mrsa","tag-recertification"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/1087","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=1087"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/1087\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=1087"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=1087"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=1087"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}