Pharmacodynamic Processes
Description of the patient case:
The patient is a 26-year-old Male, who presented to our ER for worsening right elbow bursitis. The patient was seen in the ER 2 days prior for the same issue, underwent a drainage procedure with documented removal of only 1cc, and was started on PO Keflex. Fluid was also sent for culture. Since the last time in the ER, the patient reported worsening pain and spreading redness around the elbow. The patient also reported some intermittent numbness and tingling in the fingers of the right hand. The patient decided to come back in due to concerns about a possible worsening infection. The patient denied any fevers/chills or other systemic symptoms. The patient denied tobacco or alcohol use.
The patient was not responding to the trial of oral antibiotics. Keflex 500mg PO QID instructed to take one tablet by mouth four times a day for 5 days. Once inpatient, the patient was started on IV vancomycin. Following the initial dose of Vancomycin 1.5gm IV loading dose, he had a mild vancomycin infusion reaction with a pruritic rash on the abdomen that resolved with PO Benadryl dose. Following doses of vancomycin were tolerated better with Benadryl pre-treatment and slowing infusion rate.