Ewwww really worried about DDs big toe, utterly manky infection

[Pantone363]

DD 3 had a v small cut in the crease under her big toe. It had a small infection which has got bigger and bigger. Today her toe is twice its size, the cut is weeping manky pus, individual blisters of pus have gone down the side of her foot and up over her toe. It's red raw where some of them have popped and bleeding in other places.

We went to the walk in centre on Monday when it was nowhere near this bad and the nurse gave antibs and stuck a steri strip over it. Went back today because its so much worse. Saw a doctor today who actually physically baulked at it . She gave new strong antibs and a dry iodine powder to cover it. She also said the nurse should not have put a steri strip on it (it just sat inside the cut until DD pulled it off)

The pharmacy didn't have the powder she prescribed and said its not even made anymore. The GP said if no improvement by 9am she needs iv antibs at the hospital. Her foot just looks worse and worse, she can't walk on it and its just gross.

Would you take to AE tonight or wait until the morn? Are the new antibs even going to make any difference by 9am?

That big red thing isn't the original injury, it's the remains of a manky pus bubble that burst and now seems to be eating away at her toe [vomit]

Really hope she's seen soon and they start getting her sorted. I think you got a slightly old fashioned GP but infections can be unpredictable.

Best wishes and best of luck. IV abs can work quickly so hopefully she is feeling a lot better by this time tomorrow. Poor baby and poor you

Hope she's been on her IV's all night and you start to see some improvement today.

You can get idosorb granules but tbh it sounds too far gone for that anyway.

Their a pain to use and go everywhere but the wettest part of the wound.

Blimey sounds horrible. i had a similar thing with my thumb when I was younger ... They used iodine powder then and alternated with me having to put my thumb in hot salted water for 5-10 mins to draw an infection out. Mind you we are talking about 40 years ago......hope you get seen and sorted out...

That's everyone, she had her iv and is looking slightly more chipper.

The gross skin that was all wet and manky (like a scab after a bath) is all coming off now [gross]

Yes the pharmacist was at the powder, he said it was red on his computer which means its not available anymore.

So glad she's brighter and feeling a bit better.

Gross but sloughing off that tissue is good, hopefully soon her foot will be nice and dry and the inflammation reducing well.

Good catch x

Glad that she gets the treatment she needed. I am not impressed with your GP though, but for future reference you can still get it for horses .

I'm usually quite confident about following my instincts but something just felt wrong after that GP consult.

Also she told me not to dress it anyway as it could become a (something) infection but today that dressed it at the hospital and said don't remove for 3 days. But they also said to stop the antibs she was taking (5th day of flucloxacillin and 2nd day of amoxicillin) I thought stopping part way through a course was a huge no no?

That makes no sense?! She said NOT to dress it at all, the hospital dressed it. The hospital said it was ok to stop the antibs early. But the A&E doc was that she had prescribed amoxicillin for a wound infection anyway...

Confused!

She's presumably had a full course of IV antibiotics that are the right ones for this particular infection, which is why you can stop the ones the GP prescribed.
Pleased to hear she's getting better

Also 5 days is a full, if short course, and stopping adjunctives is slightly different to stopping sole treatment.

As the tissue has sloughed off they are probably using specific dressings (like alginates) to help with discharge and healing- using a dry dressing in a suppurating wound (like melolin) as we would do at home can form a bacteria hot bed that ramps up the load. As well as other infection issues with blisters of pus and raised skin. Not dressing can be beneficial, particularly in a home environment. The doctor was also assuming use of the iodine powder which has antibacterial and drying properties (if I have understood your op).

Now her wound has changed and so it needs managing differently, that's ok.

But, if you don't feel right or don't understand why the advice has changed, that isn't ok and your dd's consultant, reg or nurse (do they have a wound care team or is it all under paed?) should be fully explaining what they are doing, why they are doing it and why it's the more appropriate treatment now.

I hope it's over for both of you soon

Oh bless! That wound looks horrid! I do hope the both of you are resting comfortably. So glad you popped her up to a&e sooner than later..

Amoxicillin on its own for a wound infection would be inappropriate, but added to fluclox is understandable, although a bit old-fashioned and not specifically advised these days. Certainly wouldn't do any harm and actually used to be standard treatment until fairly recently. The reason for the change is that it doesn't add anything to the fluclox, not that it's wrong as such.

This kind of infection can change rapidly, and if the patient is systemically well, a trial of managing with oral antibiotics is entirely appropriate. I don't think the GP has really done that much wrong here.

Stopping them, if she is now on iv antibiotics is entirely appropriate. She doesn't need both.

Ah this is why I love MN! Thanks for explanations and advice everyone.

Round, I'm a podiatrist and I've seen plenty of patients prescribed amoxicillin for foot wounds. It's such a waste of a prescription because you're only going to have to send them back to the gp for flucloxacillin.

I even had an nhs gp refuse to prescribe antib to a child because she believed in homeopathy.

update

I've taken the dressing off that they put on (they said 3 days) and her toe is still grim! As soon as you bend it forward green pus comes out of the original cut and another big cut above it where a pus bubble popped. Also where the skin has sloughed off it now extends 360 around the top of her toe and back to the original cut, that's all weeping clear fluid and bleeding in some places...

Back to the hospital? Walk in centre?

I'd say hospital, they treated it last time.

Did they actually swab the wound to find out which bacteria it was or just whack antibiotics in?

No they didn't swab which is what the original at the walk in said they would need to do if it didn't clear up.

It still looks infected and she's not on antibs now so it's just going to get worse again? I might bathe it in some cool water and see if the pus/bleeding is just because its been dressed?

I'm going to feel like a right nob going back to A&E with her toe again (I have issues with feeling like I'm wasting people's time)

I wouldn't worry about wasting time.

She's got pus coming out of a wound and no antibiotic cover, I'd go back because unless your dealing with an elderly person with poor peripheral circulation the antibiotics work very quickly.

No, that sounds properly skanky, I think you should go back. It doesn't seem like it the anti bs are really getting to the root of the problem. If they do a swab they can find out exactly what it is. Definitely go back.

Hospital. ASAP. My dad lost a toe in very similar circumstances (he's diabetic, not trying to scare you). If it had been treated properly in the first place he would still have it.

Back to hospital for your poor DD.