Cellulitis

Antimicrobial prescribing: NHS Lothian
NHS Lothian

Human and animal bite guidelines are available here.

Follow guidelines here for severe skin soft tissue infection in a person who injects drugs.

Assessment

  • Ensure elevation of affected limb.
  • Demarcate erythema on leg to help assess responses/spread.

Required Investigations

  • Would swab for bacterial culture, if there is an open would, drainage, or an obvious portal for microbial entry
  • Blood cultures (10mls per bottle) for severe cases, before starting IV antibiotics

Antimicrobial recommendation

Mild infection
Recommended total duration: 5 days (Total duration = IV + oral

Antibiotic recommendation

 

 Flucloxacillin 500mg-1g every 6 hours orally 
Penicillin allergy or previous MRSA(if MRSA check prior sensitivities)

Doxycycline 200mg first dose then 100mg every 24 hours orally

OR

Clarithromycin 500mg every 12 hours orally
Severe infection
Recommended total duration: 7 days (Total duration = IV + oral)

Antibiotic recommendation

 

 Flucloxacillin 2g every 6 hours IV
Penicillin allergy or previous MRSA Vancomycin IV (use NHS Lothian Calculator on AMT intranet page) choose trough 10-15 mg/L

 

IV to oral switch

Antimicrobial recommendation

 

 Flucloxacillin 1g every 6 hours 

Penicillin allergy OR previous MRSA(if MRSA check prior sensitivities)

Doxycycline 100mg every 12 hours

OR

Clarithromycin 500mg every 12 hours