CASE PRESENTATION ON

CELLULITIS

PRESENTED BY : SANA RAFEEQ

(170715882024)
PharmD VI/VI

Under the guidance of

Dr.Maryam
Asst. Professor
Department of Pharmacy Practice
Deccan School of Pharmacy
 CELLULITIS
Cellulitisis a bacterial infection of the skin and tissues beneath the skin. Unlike impetigo, which is a very
superficial skin infection, cellulitis is a bacterial skin infection that also involves the skin's deeper layers: the
dermis and subcutaneous tissue. Cellulitis is a common infection of the skin and the soft tissues underneath. It
happens when bacteria enter a break in the skin and spread.

Etiology:
●The main bacteria responsible for cellulitis are Streptococcus and Staphylococcus ("staph"), the same bacteria
that can cause impetigo and other diseases. 
●MRSA (methicillin-resistant Staph aureus) can also cause cellulitis.
●Other bacteria (for example, Hemophilus influenzae, Pneumococcus, and Clostridium species) may cause
cellulitis as well.
●Injuries that tear the skin
●Infections after surgery
●Long-term skin conditions such as eczema or psoriasis
●Foreign objects in the skin
●Bone infections underneath the skin. (An example is a long-standing, open wound that is deep enough to
expose the bone to bacteria.)

.
signs and symptoms:
●Redness
●Pain and tenderness, swelling, and
warmth of the affected area.
●Cellulitis can occur anywhere in the body.
●Cellulitis frequently affects the legs.
●Cellulitis is not contagious

Complications :
Include spread of the infection into the
bloodstream or to other body tissues.
DEMOGRAPHIC PROFILE

• PATIENT’S NAME : XYZ

• I.P No. : R120-002297
• AGE : 60 yrs
• WEIGHT: 90kgs
• GENDER: Female
• UNIT : General Medicine
• DOA : 05-02-20
• DOD : 08-02-20
SUBJECTIVE DATA

 A 60 years old female patient was admitted in the general

medicine ward with chief complaints of fever,SOB, swelling
of left limb and nausea.

 Past medical history:

 The patient has a history of taking excessive painkillers.
(opiod analgesics like morphine)
 She is obese and suffering from CAD
 On Tab clopitab A(aspirin and clopidogrel)-OD

 PROVISIONAL DIAGNOSIS:CELLULITIS
 OBJECTIVE DATA

 O/E The swelling on her leg is warmth tender and erythematous

 The following test were advised by the physician.
 CRP
 CBP
 ASO TITRE
 ESR
 ELECTROLYTES
 D.DIMER
BLOOD UREA
 CREATININE
 HS TROPONIN
ABNORMAL VALUES

TEST FINDINGS NORMAL VALUE

HS TROPONIN 51 UPTO 19
D-DIMER 400ng/mL Up to 200
ESR 1ST HOUR 50mm 0-5mm
ESR 2ND HOUR 90mm 5-10mm
ASO TITRE Positive -
RA FACTOR negative <10 IUL
WBC 12000CELLS/CUMM 7000-11000
CELLS/CUMM
 FINAL DIAGNOSIS:CELLULITIS
ASSESSMENT

 PROBLEM 1: PAST HISTORY OF CAD

 PROBLEM 2: SHORTNESS OF BREATH
 PROBLEM 3: PAIN AND FEVER
 PROBLEM 4: NAUSEA
 PROBLEM 5: PEDAL EDEMA
 PROBLEM 6: INFECTION (CELLULITIS)
PLAN
 PROBLEM 1: SHORTNESS OF BREATH
 MEDICATIONS: nebulizer duolin and budecort every 4th hourly

 PROBEM 2: PAIN AND FEVER

 MEDICATIONS: inj PCM(paracetamol) IV Stat

 PROBLEM 3: INFECTION (CELLULITIS)

 MEDICATIONS: inj monocef(ceftriaxone) IV 1 gram.
 Inj.dalacin(clindamycin) 600mg /iv/TID

 PROBLEM 4: NAUSEA
 MEDICATIONS: inj zofer(ondansetron) 4mg IV
PROBLEM 5: PEDAL EDEMA
 MEDICATIONS: TAB CHYMORAL FORTE (trypsin and
chymotrypsin)TID

 PROBLEM 6: PAST HISTORY OF CAD

 MEDICATIONS: TAB CLOPITAB A (75/150)mg ( ASPIRIN AND
CLOPIDOGREL)

 Ulcer prophylaxis- inj pan (pantoprazole) 40mg IV-BD was given

 TREATMENT CHART
BRAND GENERIC DOSE FREQUENCY ROUTE DAY DAY DA DA
NAME NAME 1 2 Y3 Y4
PAN Pantoprazole 40 mg OD IV    
ZOFER Ondansetron 4mg OD IV X   
PCM Paracetamol 500mg SOS IV   X X
MONOC Ceftriaxone 1g BD IV    
EF
DUOLIN Salbutamol 2.5ml 4TH HOURLY NASAL   X X
BUDECO ,ipratropium
RT br
/Budesonide
NS AND Normal 50ml/h SOS IV    
RL saline and r
ringers
lactate
DALACI clindamycin 600mg TID IV    
N
Cloptab- Clopidogrel+ 75mg OD O    
A Aspirin
DAY NOTES
 DAY 1
 VITALS:
 Temp:102F
 BP 120/80 mmHg
 PR:83/min
 RR:20/min
 Chief complaints: SOB, fever, swelling and erythematous left limb
 Day 2
 VITALS:
 Temp:100F
 BP 120/80 mmHg ,PR:81/min, RR:21/min
 Chief Complaints :nausea
 Day3
 VITALS:
 Temp 98.4F ,BP 120/80 mmHg, PR:75/min, RR:19/min ,SOB subsided
 Fever subsided and patient is responding to treatment
 Day 4
 Temp: 98.4F ,BP :120/80 mmHg, PR:77/min, RR:20/min
 Patient is responding and all the vitals are stable and hence the patient can be discharged.
DISCHARGE MEDICATION:

 Tab.Pan(pantoprazole) 40mg OD (BEFORE

BREAKFAST)
 Tab Dolo (paracetamol) 650 mg SOS
 Tab Motrin(ibuprofen) 400mg SOS
Tab Dalacin(clindamycin) 300 mg QDS
 Duration of therapy : 7days
 Review in op dept after 7 days
PHARMACIST INTERVENTIONS:
 BUDESONIDE + CLOPIDOGREL
Budesonide will increase the level or effect of
clopidogrel by affecting hepatic/intestinal enzyme
CYP3A4 metabolism.CYP3A4 inducers may increase
the metabolism of clopidogrel to its active metabolite.
Monitor patients for potential increase in antiplatelet
effects when CYP3A4 inducers are used in combination
with clopidogrel.
The patient’s past habit of taking opiod
analgesics might be the reason for the development of
cellulitis hence a simpler NSAID like paracetamol was
suggested.
PATIENT COUNSELLING
 REGARDING DISEASE
 Cellulitis is a common, potentially serious bacterial skin infection. The affected
skin appears swollen and red and is typically painful and warm to the touch.
 Cellulitis usually affects the skin on the lower legs, but it can occur in the face,
arms and other areas. It occurs when a crack or break in your skin allows bacteria
to enter.
 Left untreated, the infection can spread to your lymph nodes and bloodstream and
rapidly become life-threatening. It isn't usually spread from person to person.
REGARDING MEDICATIONS:

 -Take tab.pan at least 30 min before food.

 -Complete the entire course of antibiotics.
 -Use liberal amount of moisturizer.
 -Take the medicines on time.
REGARDING LIFESTYLE
MODIFICATIONS:
.Proper rest and elevation of the affected area.
.Regular antiseptic soaks
.Rarely visit to dermatologist (if needed).
.Painkillers such as pcm are useful to ease pain.
.Elevation of the leg means that your foot must be higher
than your hip
.While sleeping place your foot on a pillow when in bed
or place something firm under the foot of your mattress
to keep the affected for elevated.
.Use a soap substitute on the affected area of the skin to
prevent it from drying, reduce itching and help healing.