Traumatic Wounds/Lacerations

Antimicrobial prescribing: NHS Borders
NHS Borders

Duration

5-7 days

Treatment of clean lacerations that become infected

Therapy

Flucloxacillin  500mg oral 6 hourly

CSM advice (hepatic disorders) see BNF

Penicillin allergy

Clarithromycin  500mg oral 12 hourly for 5 to 7 days

Consider antimicrobial prophylaxis if patient is immunocompromised e.g. diabetic, asplenic, alcohol dependant or laceration is stellate, intra-oral or to the feet.  Antibiotics are as for treatment.

Notes:

Treatment of infected lacerations that were previously contaminated; puncture wounds or wounds with a significant amount of devitalised tissue

Therapy

Co-amoxiclav (Amoxicillin / Clavulanic acid) 375 – 625mg oral 8 hourly

Penicillin allergy

Clarithromycin 500mg oral 12 hourly

plus

Metronidazole 400mg oral 8 hourly

Consider antimicrobial prophylaxis in puncture wounds or wounds contaminated with soil, manure or faeces and wounds with a significant amount of devitalised tissue.  Antibiotics are as for treatment.

Notes:

Notes

Wound infection occurs in 1 – 12% of all non-bite wounds.  Antibiotic prophylaxis or tetanus immunoglobulin is not usually required for simple, clean lacerations.

For high risk tetanus prone wounds (heavily contaminated with soil / faeces or devitalised tissue) human tetanus immunoglobulin should be given, irrespective of the tetanus immunisation history of the patient.

A tetanus containing vaccine is given if necessary, according to immunisation history.

Ref:  Green Book, Tetanus (chapter 30)

https://www.gov.uk/government/publications/tetanus-the-green-book-chapter-30