Important: Therapy

• Take appropriate specimens before starting therapy, including sending blood for culture if severe.
• Consider the necessity for surgical intervention, tetanus prophylaxis and topical cleaning.
• Chronic wounds such as pressure sores and leg ulcers do not require antibiotics unless there is clinical evidence of infection eg cellulitis, discharge or acute pain.
• Skin takes some time to return to normal and full resolution of symptoms at 5 to 7 days is not expected.
• Longer courses may be required in severe infections.
• Patient may be suitable for Outpatient Parenteral Therapy - see Infectious Diseases Grampian Guidance page. 
• Separate guidance for Pre-septal Cellulitis or Orbital Cellulitis is available.

Notes:

Important: Therapy

Patients with no uncontrolled co-morbidities and not yet tried oral antibiotics

Oral Flucloxacillin 1g four times daily

Notes:

Important: Therapy

Patients with no uncontrolled co-morbidities and not yet tried oral antibiotics

Oral Doxycycline 100mg twice daily

Notes:

Important: Therapy

IV Flucloxacillin 1 to 2g 6 hourly (use 2g if BMI more than 30 kg/m²)

Switch to

Oral Flucloxacillin 1g four times daily

Notes:

Important: Therapy

Vancomycin IV as per guideline

Use calculator for intermittent dosing.

Switch to

Oral Doxycycline 100mg twice daily

Notes:

Important: Therapy

Do not routinely offer antibiotic prophylaxis to prevent recurrent cellulitis or erysipelas.

Refer to NICE Guideline 141 Cellulitis and erysipelas: antimicrobial prescribing for advice on when antibiotic prophylaxis may be appropriate. 

Refer to Guidelines on the Management of Cellulitis in Lymphoedema

Choose antibiotics according to recent microbiological results when possible, and avoid using the same antibiotic for treatment and prophylaxis.

First line: Oral Phenoxymethylpenicillin 250mg twice daily

Penicillin allergy: Discuss with an infection specialist.

Notes:

Review at least every 6 months.