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Greetings-
The physician ordered the following:
POSTTRAUMATIC WOUND INFECTION, SUBSEQ
Note: sp shingles, worse with manipulation,
Plan: Mupirocin (BACTROBAN) 2 % Top Oint - Apply to affected area(s) 2 times a day
HOME HEALTH REFERRAL ORDERS

Please see photos and advise. Thanks.
Mar 26, 2019 by Amy Smith, JD, RN, PHN
3 replies
Elaine Horibe Song
MD, PhD, MBA
Hi Amy,
Thanks for sharing this interesting case. A few questions to help clarify:
- Has diagnosis of herpes zoster (HZ) been confirmed in this case? How long ago was he diagnosed w HZ?
Has he been treated for HZ (e.g oral acyclovir)? Has he had an eye examination? (if in fact HZ, probably affects CN V1, which is usually associated with conjunctivitis, etc, requires longer antiviral treatment and may require hospital admission.
- If HZ, lesions don't look completely healed yet - are new lesions still appearing? If so, continued antiviral treatment is recommended even if onset >= 72h
- As for associated infection, would you know if patient is immunosuppressed (condition or treatment)? In that case patient may need prolonged and/or IV antiviral treatment. His eyelid seems swollen, which may have orbital cellulitis. Also, his scalp lesion seems to affect dermis (can't tell exactly on the picture). If so, he'll need oral or IV antibiotics for 7-10 days (not only topical). eg, amoxicillin/clavulanate, cefuroxime axetil, cefpodoxime proxetil, and cefdinir). If he hasn't had a consultation with ophthalmology it seems reasonable to have one.
Mar 26, 2019
Amy Smith
JD, RN, PHN
Thanks Elaine and I will check with the PCP. Do you think the dressing is appropriate this time assuming we follow through on the other items?
Mar 26, 2019
Elaine Horibe Song
MD, PhD, MBA
Hi Amy
I think topical antibiotics with coverage against gram positive (ie Mupirocin (BACTROBAN) 2 % Top Oint) helps, but might not be enough to address infection and prevent complications given proximity to eye, size/depth of wound. If HZ lesions still active, may use wet-to-dry dressings with sterile saline solution or Burow solution for 30-60 minutes 4-6 times daily. Let me know how it goes :)
Mar 26, 2019
* Info provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional.