2.  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

3.  Incision and Drainage of Abscess ◦ 20cc purulent discharge ◦ Specimen sent for GS/CS  For daily COD

5. Complete Blood Count Hgb110 RBC4.11 Hct0.33 MCV79.90 MCH26.80 MCHC33.50 RDW14.00 MPV6.20 Platelet281 WBC12.10 Neutrophils0.54 Lymphocytes0.41 Monocytes0.03 Eosinophils0.02 Microbiology Examination Gram (+) Cocci in PairsFew Pus Cells++++

6.  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

7. Culture and Sensitivity: Wound Discharge Staphylococcus aureusHeavy Growth *MRSAPositive Sensitive to: AzithromycinChloramphenicolClindamycin ErythromycinGentamycinCo-trimoxazole Vancomycin Resistant to: Penicillin

8.  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

10.  Day 14 ◦ 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.  Disharged ◦ 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