Skin, Soft Tissue and Musculoskeletal

For preseptal or periorbital cellulitis see Ophthalmology guidance: periorbital or preseptal cellulitis

Treatment 

Flucloxacillin (IV or oral)

If true penicillin allergy:

Clindamycin (IV or oral)

Duration: 7 days

Seek surgical review. Urgent surgical debridement is crucial.

Theatre specimens should be sent for microscopy and culture to help determine aetiology. Contact microbiology labs to arrange urgent examination.

Meropenem IV (Maximum dose)

Plus

Clindamycin IV (Maximum dose)

The primary treatment for this condition is urgent surgical debridement.

Antibiotics have only a secondary role in therapy.

Gangrene develops in anaerobic areas with limited blood flow. Therefore, antibiotics do not penetrate and only protect contiguous areas.

Benzylpenicillin IV

Plus

Clindamycin IV

If true penicillin allergy:

Vancomycin IV

Plus

Clindamycin IV

Give antibiotic prophylaxis in all human, cat, dog and puncture bites, especially when hand, foot, face, joint, tendon, ligament involved; or when patient immunocompromised, diabetic, asplenic, cirrhotic, presence of prosthetic valve or prosthetic joint

If accompanied by marked cellulitis consider parenteral antibiotic therapy and seek plastic surgery advice.

Wound care and irrigation is very important

Consider tetanus prophylaxis

Assess risk of tetanus; HIV; hepatitis B&C; in human bites and rabies in animal bites

If bite was sustained abroad or if any other animal was involved, seek Microbiology advice

Co-amoxiclav IV or Oral

If true penicillin allergy:

Co-trimoxazole Oral

Plus

Metronidazole Oral

Duration: 7 days

Clean procedure

Flucloxacillin IV

If true penicillin allergy:

Clindamycin IV

If MRSA risk:

Vancomycin IV

Contaminated procedure

Take blood cultures and send joint aspirates for culture before starting empirical antibiotic therapy.

Cefotaxime IV

If true penicillin allergy:

Contact Microbiology

Initial intravenous therapy for 14 days, then duration of oral therapy will depend on sensitivities. If cultures negative then use 4 weeks oral co-amoxiclav

Flucloxacillin IV

Plus

Clindamycin IV

If true penicillin allergy:

Clindamycin IV

Initial intravenous therapy for 72 hours, then duration of oral therapy will depend on sensitivities. If cultures negative then use 4 weeks oral co-amoxiclav

In all cases seek specialist orthopaedic advice at the outset.

Do not start antibiotic therapy until appropriate samples have been obtained for culture.

In children >3 months to 5 years of age consider Kingella kingae. If unresponsive to initial therapy consider changing to ceftriaxone.

Seek specialist orthopaedic advice.

Appropriate specimens should be taken for culture prior to starting therapy