Leg Ulcer

NHSL Antimicrobial Guidelines
NHS Lanarkshire

Leg ulcer

CKS: Leg ulcer - venous

Ulcers always colonised. Antibiotics do not improve healing unless active infection.

If active infection, send pre-treatment swab. Sampling for cultures requires cleaning then vigorous curettage and aspiration.

Review antibiotics after culture results.

For management of diabetic foot ulcer: Send wound swab. Inform diabetologist/podiatrist. Mild infection as below and if anaerobic infection suspected add Metronidazole 400mg 8 hourly. Seek advice in moderate/severe infection and always consider MRSA.

Drug details

Drug

Active infection if cellulitis/increased pain/pyrexia/purulent exudate/odour.

If active infection:
Flucloxacillin

Duration

For 7 days. If slow response continue for a further 7 days.

Diabetic Foot infection: 14 days

Drug

Or:
Clarithromycin

Duration

For 7 days. If slow response continue for a further 7 days.

Diabetic Foot infection: 14 days

Editorial Information

Last reviewed: 22/03/2021

Next review date: 22/03/2024

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick.

Approved By: AMC; ADTC

Reviewer name(s): NHS Lanarkshire Antimicrobial Management Committee.