Long term antibiotic prophylactic
We have a situation where a patient is being seen for antibiotic injections for non active cellulitis. There is no redness, inflammation or signs of infection however the patient cannot go off the antibiotic injections without getting infected again.
Decision health states for Z79.2 (Cannot be primary)-consider the confirmed diagnosis for which the patient is under treatment with the medication. I am unsure if I should code the cellulitis even though it is non active.
Decision health states for Z79.2 (Cannot be primary)-consider the confirmed diagnosis for which the patient is under treatment with the medication. I am unsure if I should code the cellulitis even though it is non active.
Comments
In cases of over-use of antibiotics I can't help but chime in. I hope this physician has medical justification for over-use of antibiotics at the risk of creating resistance! If this is not an Infectious Disease Specialist I would present this case to my Medical Director and have them call this physician and inquire as to the medical necessity for this (abuse) use of antibiotics in the absence of infection and it not be within the realm of proven practice to do so in that situation. Perhaps it is given some new study... At any rate, I would not want to be responsible and liable for unproven medical intervention if that is what it is. Even if it is an ID doc, I would still like to know if it is proven practice to do this in light of "preventative" intervention.
Interesting question. I will investigate further and let you know if I find something out.
You could use the codes for hx of infection...? I would request documentation of cultures and the doc's interpretation of those cultures before I would code it however as skin cultures contain all kinds of flora.
Nancy Wolverton RN, CCM, HCS-D-10
Utilization Review Specialist
Kindred at Home
Little Rock, Arkansas
501-508-8526 (o)
501-690-2027 (c)
Nancy.Wolverton@kindred.com
Recurrent Cellulitis
Patients with lymphedema or severe venous insufficiency of their extremities are at increased risk of recurring β-streptococcal cellulitis. Common scenarios for recurrent cellulitis of the lower extremity include patients with venous insufficiency after saphenous vein graft harvesting or pelvic lymphadenectomy. Recurrent cellulitis has been observed in the upper extremity after lymphadenectomy performed at the time of mastectomy for breast cancer. Antimicrobial prophylaxis may be a useful addition to the control of lymphedema with local measures and treatment of concurrent tinea pedis in the prevention of recurrent cellulitis. However, this recommendation is based on small, uncontrolled studies.26-28 Typically, more than 2 or 3 episodes per year should occur before AP is initiated. Recommended prophylactic antibiotics for recurrent cellulitis are summarized in Table 1. Oral penicillin V (phenoxymethylpenicillin) is a reasonable first choice, but optimal dosing of this agent is not well established.5-7 Although monthly administration of 1.2 MU of intramuscular benzathine penicillin is recommended as an alternative to oral penicillin V, this dosing regimen was shown to be effective only in those patients not at risk of cellulitis recurrence.28 Some experts recommend intramuscular administration of benzathine penicillin every 2 to 3 weeks for individuals who break through once-monthly intramuscular benzathine penicillin regimens.5
Recurrent pyogenic skin infections caused by Staphylococcus aureus, including methicillin-resistant S aureus (MRSA), may be managed by encouraging good personal hygiene, the avoidance of shared personal items, and the diligent cleaning of high-touch environmental surfaces. If a patient is found to be colonized by S aureus, nasal decolonization with mupirocin for 5 to 10 days with or without a topical body decolonization with a skin antiseptic solution such as 4% chlorhexidine for 5 to 14 days may be reasonable in an attempt to decolonize the patient.8 Antimicrobial prophylaxis options are listed in Table 1 for recurrent methicillin-susceptible S aureus skin infections.9,29 Long-term oral AP of recurrent MRSA skin infections is not well studied, and formal recommendations for this situation were not included in recently published MRSA treatment guidelines
This was submitted from the Mayo Clinic in 2011. Most I quickly read do not show any real difference in prevention rates vs non-treated rates of cellulitis recurrence. The abstract ends with this recommendation:
"Antimicrobial prophylaxis should be of short duration to decrease toxicity and antimicrobial resistance and to reduce cost."
Nancy Wolverton RN, CCM, HCS-D-10
Utilization Review Specialist
Kindred at Home
Little Rock, Arkansas
501-508-8526 (o)
501-690-2027 (c)
Nancy.Wolverton@kindred.com
In the trial presented, the primary outcome showed "significant effect (with abx prevention) was not sustained after prophylaxis ceased". This also mentions costs involved as the patient has a co-pay for the antibiotic drug dispensed by the pharmacy to have on hand for the home nurse to administer, and the list of side-effects was extensive.
Nancy Wolverton RN, CCM, HCS-D-10
Utilization Review Specialist
Kindred at Home
Little Rock, Arkansas
501-508-8526 (o)
501-690-2027 (c)
Nancy.Wolverton@kindred.com
Nancy Wolverton RN, CCM, HCS-D-10
Utilization Review Specialist
Kindred at Home
Little Rock, Arkansas
501-508-8526 (o)
501-690-2027 (c)
Nancy.Wolverton@kindred.com