[CARPA] CAMRSA

[Christine.Connors at nt.gov.au]

Malcolm McDonald at menzies has been doing some research on community aquired
MRSA in NT
we are seeing about 20% of staphs are resistant

the revised carpa guidelines for impetigo continue to recommend benzathine
penicllin as first line treatment, cepahlexin as oral alternative if parents
refuse injection, although wont eradicate strep. the experinece still is that
benzathine heals impetigo despite staph growing in swabs (ie: it seems to be a
commensal rather than cause)

for boils : messages will be: attempt drainage, cover, cover, cover till boil
healed to stop autoinoculation, this may be a significant factor in recurrent
boils, very few people coming up with positive nasal swabs but still keeping
that as a possible step, advising on increased swabbing to monitor sensititives,
and reviewing and treating according to lab results (dicloxacillin/fluclaxillin
still first line in antibiotics required).
rifampicin is final option for eradication

This is of course still aimed at individuals. in east arnhem healthy skin
project which aims to reduce scabies and skin sores, we have seen significant
reduction in skin sores, reduction in severity of scabies, but havent got data
on impact on boils.


proposed revision  in skin chapter CARPA 5th edition
If the person keeps getting boils
·     Check BGL for diabetes (see Blood Glucose Test)
      swab to check sensitivities
·     1. Treat with cotrimoxazole
·     2. Talk with a doctor, they may need a different antibiotic due to
resistant germs
·     3. Wash daily with aqueous chlorhexidine soap to reduce carriage of staph
aureus
·     If still getting boils
      - Take a nasal swab for MC+S (for Staph. aureus)
      - Consider nasal mupirocin 2% nasal ointment twice a day for 10 days if
nasal swab grows staph aureus
·     4. Consider rifampicin 10 days if persistent boils after the all other
treatments have failed


Dr. Christine Connors
Program Director PCD
NT Department of Health & Community Services
Phone: (08) 8922 8218
Fax:      (08) 8922 7714
Mobile: 0401 116 121
email: christine.connors at nt.gov.au









                                                                                
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                                         [CARPA] CAMRSA                         
                                                                                
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When I worked at Bourke last year, and at Brwewarrina this and last year there
has been, and is an endemic problem with community acquired MRSA in the kids
spreading to susceptible adults (diabetics and alcoholics). Dishing out
Clindamycin and Contrimaxazole eradicates the infection in individuals but
they're back within a few weeks to a few months with reinfection.Those with
imetigo also get a macrolide.
This is ultimately going to select a CAMRSA resistant also to Clindamycin and
sulphonamides.
Has anyone in CARPA tried to tackle this problem as a public health issue. What
did you do? did it work?
--
David Brookman
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