Cellulitis

Antimicrobial prescribing: NHS Lothian
NHS Lothian

Aspects of care:

  • Elevate limb in Bradford sling.
  • Irrigate wounds thoroughly

Required investigations

    • FBC, U+E, LFT, CRP
    • Blood cultures
    • Wound swab if skin break down
    • Hand XR (check for gas in soft tissues) 

 

Necrotising fasciitis

For necrotising fasciitis see here.

Human and animal bites

For human or animal bites see here.

Tetanus prone wounds

Tetanus-prone wounds should receive tetanus immunoglobulin regardless of vaccination status.
Tetanus prone wounds/burns include those with the following features:

        • Open fracture
        • Foreign body
        • Patient has systemic sepsis
        • Required surgical intervention is delayed by >6 hours
        • Injecting drug users who have injected tetanus-contaminated material
        • Significant amount of devitalised tissue or puncture-type injury, particularly when there is contact with soil/manure

Rabies

Consider rabies from any mammal bite

Discuss prophylaxis with ID Registrar
Current PHE Guidelines on Rabies PEP can be found here.

Consider the following points

  • Irrigate under running water with soap/detergent for several minutes followed by disinfectant (40-70% alcohol or aqueous solution of povidone-iodine)
  • Suturing or injection of anaesthetic may increase the risk of introduction of rabies virus - it should be avoided or postponed.
  • See Human and animal bites for further guidance.

Antibiotic recommendation mild cellulitis

Total recommended duration: 7 days

Recommended antibiotics Flucloxacillin 500-1000mg every 6 hours orally
Penicillin-allergy OR Previous MRSA

Doxycycline 100mg every 12 hours orally

People who inject drugs, due to high rates of Group A Streptococcal resistance to Doxycycline , consider discussing with microbiology, an alternative may be:

Clindamycin 600mg every 8 hours orally

 

Antibiotic recommendation severe cellulitis

Total recommended duration: 7 days

Recommended antibiotics Flucloxacillin 2g every 6 hours IV
Penicillin-allergy OR Previous MRSA Vancomycin use NHS Lothian Calculator located on AMT Intranet page

 

 

 

 

 

 

 

IV to oral switch

Recommended antibiotics Flucloxacillin 500mg every 6 hours orally
Penicillin-allergy OR Previous MRSA

Doxycycline 100mg every 12 hours orally

In people who inject drugs, due to high rates of Group A Streptococcal resistance to Doxycycline , check microbiology sensitivity results. Consider discussing with microbiology, an alternative may be:

Clindamycin 600mg every 8 hours orally