Treating Secondary Infection In A Patient With Severe Tinea Pedis

Michael Moharan, DPM, Mohamed Abdelmegeed Ahmed, MD, DPM, and Oleg Karpenko, MD, DPM

   In our case, we used all appropriate diagnostic, therapeutic and prophylactic tools recommended by many authors to succeed in treatment of the patient. Some authors also recommend treatment with topical amikacin 5% gel (Amikin, Sopharma), Castellani paint and compresses with 2% to 5% acetic acid, which we might add to our treatment approach. In terms of antibiotic treatment, in our opinion, a first-generation quinolone such as ciprofloxacin might be more effective versus the second-generation levofloxacin or third-generation moxifloxacin that cover gram-negative organisms but are more active against gram-positive flora.

   In addition, the patient was getting treatment in different wound care facilities for long periods of time with medications such as amoxicillin-clavulanate and antifungal creams that were not covering P. aeruginosa infection. This might lead to antibiotic resistance.

   Dr. Moharan is the Former Chief Podiatry Resident at St. John’s Episcopal Hospital in Far Rockaway, N.Y. and Senior Resident at Kennedy University Hospital in Turnersville, N.J.

   Dr. Ahmed is a Former Chief Podiatry Resident at Mount Sinai Hospital of Queens, N.Y. and currently a Wound Care Fellow at St. John’s Episcopal Hospital.

   Dr. Karpenko is Former Chief Resident at Kingsbrook Jewish Medical Center in Brooklyn, N.Y. and is currently practicing in Brooklyn.

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I have seen patients with Pseudomonas aeruginosa infection secondary to interdigital fungi infection. Instead of using topical cream, I use silver dressing with exudate control ability such as Aquacel Ag or Acticoat with aligiste m, together with oral antibiotics. The infected toe webs dried up, became less swollen and the foot healed up within two weeks.

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