1. Charles Krasner, M.D. University of NV, Reno School of Medicine Sierra Nevada Veterans Affairs Hospital

3. Streptococcus- spreads widely along tissue planes. No pus should be found. If there is any pus, there is more than strep there! Staph aureus/MRSA – produces localized pus and abscesses with small area of surrounding erythema, rather than diffuse inflammation.

13. Recent study cultured 2595 spots in public locations throughout the United States:  Airplane tray tables- 60% MRSA positive +  Public bus grab poles/push handles - 66.7% +  Office desktops/phones- 33% +  Rental car steering wheels- 9.1% +  Public restrooms – 6.3% + Author comment: “ I try not to use airline tray tables, and I would never put food down on one”

14.  https://youtu.be/cunCh4myj_U https://youtu.be/cunCh4myj_U

23. Singer AJ, Talan DA. N Engl J Med 2014;370:1039-1047 II. Empirical Oral Antibiotic Regimens Recommended for Selected Patients with a Presumed Methicillin-Resistant Staphylococcus aureus (MRSA) Abscess.

24.  Decide if the rash is strep, staph or something else (syphilis, anyone?)  If strep- use drugs effective for strep- ceftriaxone, cefazolin or unasyn in the hospital; amoxicillin, Augmentin, cephalexin for out-patient  If it is likely a staph infection, treat on the assumption it is MRSA –clindamycin, Bactrim, vancomycin, linezolid or doxycycline  If you are not sure, Augmentin BID and Bactrim DS BID covers strep,MSSA and MRSA  If it is an abscess, drainage is paramount  Antibiotics may not be needed unless abscess is large and inflamed appearing. Drainage is most important