You are reviewing Mr AC who has been admitted to hospital with purulent cellulitis unresponsive to oral cloxacillin for ten days.

His past medical history includes hypertension, Type 2 diabetes mellitus, chronic obstructive pulmonary disease (‘COPD’), obesity and anxiety disorder.

Mr AC is allergic to sulphonamide and his regular medications at home include: 

• Tiotropium 18mcg inh daily 
• Seretide inhaler 250mcg/25mcg 2 puffs inh BD 
• Salbutamol 100mcg Metered-dose inhaler (MDI) 1-2 puffs inh QID PRN for SOB 
• Lisinopril 10mg po daily 
• Insulin glargine (Lantus®) 15 units s/c night 
• Multiple Prednisolone courses over the past year for COPD exacerbation 
• Sertraline 50mg po daily 

Vital signs on admission: RR 23, HR 100, BP 165/95, temperature 38.2°C, O2 sat 98% on room air

Laboratory results:

Culture results from purulent skin discharge: 

Specimen: skin discharge sample 2021-06-03

Organism 1: methicillin resistant Staphylococcus aureus (‘MRSA’)

Note: Vancomycin MIC 3.5μg/mL 

Diagnosis: community-acquired-MRSA purulent cellulitis 

(a) Discuss the potential adverse effects from long term use of corticosteroid, particularly the ones that may be exacerbating Mr AC’s condition. (5 marks)

(b) Given Mr AC’s presentation and laboratory test results, discuss the treatment options for his MRSA purulent cellulitis. Include in your discussion the different clinical considerations for each of the potential options available. (5 marks)

(c) Apart from the management of Mr AC’s infection, identify TWO more drug related problems of Mr AC and make appropriate recommendations accordingly. (5 marks)