Need to vent
Hiii I've had reoccuring impetigo for two years now. I'm currently my third derm. My first derm said it was normal and just perioral dermatitis and acne. None of her treatments worked. Side note she put me on doxy for acne but it didn't help impetigo. The second derm immediately said that it was a staph infection and put me on cephalexin. That didnt work so she did a pcr (not a culture) which only showed acne n malasezia. We did a second test in case and she said it was the same thing and said we could try accutane. I declined. Because she said there was no staph I assumed I had some weird disease that couldn't be treated. After talking to other doctors they said it was prob came out negative cuz I did them after antibiotics. Now with my third derm she asked me for my swab results from my previous derm so I obtained them and saw that the second one actually did have staph on it albeit it wasn't a lot. I also saw that it wasn't the typical staph aureus and was actually a few strains of coagulase negative staph. So this derm puts me on fluconozole for a month to help with my seb derm and tells me to use mupirocin in my nose for one week a month for three months. Ive already tried mupirocin in my nose before this twice, once on my own and the other at the suggestion of my second derm. At my one month follow up I tell her it hasn't gotten better. I really wanted to ask her for a culture sensitivity test. This is where they grow bacteria in a petri dish and use antibiotics on them to see which one its most sensitive to. The pcr test i had gotten previously tested for resistance genes but not sensitivity. As per the pcr, doxy n cephalexin should've worked because its not resistant. I think it didn't work because the bacteria is not very sensitive to it. When i asked her she said pcr is the best n said it shows sensitivity (it doesn't, it shows resistance genes). The pharmacist recommendation on the pcr said to use amoxicillin which is what my derm then prescribed me. I have already been on cephalexin and doxycycline and and hesitant to try an antibiotics if it just comes back again. I dont want to end up trying a bunch of antibiotics, i want to try the right one. I feel like sensitivity/susceptibility would show what actually works versus predicting what could work. Ive gotten two cultures at urgent cares but they either say normal skin flora or one said rare gram positive cocci (so only a tiny amount). I think the samples might've been bad cuz I rarely ooze crust now (mostly get red and inflamed). Im not sure what to do. Should I just take the amoxicillin? Even if I get another culture from an urgent care the staph might not show up. Sry for the long read. Any advice is appreciated.