We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.
You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.
To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:
On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.
On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.
Please get in touch with ann.wales3@nhs.scot with any questions.
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
Co-amoxiclav IV
If MRSA risk:
Add Vancomycin IV
If true penicillin allergy:
Vancomycin IV
Plus
Ciprofloxacin IV (before prescribing review MHRA Safety Advice )
Plus
Metronidazole IV
Send a wound swab for culture prior to initiating treatment. Further therapy should be guided by laboratory results.
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
Antimicrobial prescribing: NHS Fife