Post-operative infection

Antimicrobial prescribing: NHS Lothian
NHS Lothian

Required investigations

    • FBC, U+E, LFT, CRP
    • Blood cultures
    • Wound swabs

Mild infection recommendation

Mild infectionTotal duration: 7 days 

Antimicrobial recommendation 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, consider discussing with microbiology, an alternative may be:

Clindamycin 600mg every 8 hours orally

 

Severe infection recommendation

Severe infectionTotal duration: 7 days 

Continue IV therapy for 24 hours after final washout / clinical improvement 

Antimicrobial recommendation Flucloxacillin 2g every 6 hours IV
Penicillin Allergy OR Previous MRSA Vancomycin IV use NHS Lothian Calculator located on AMT intranet page
IV to oral switch 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 and consider discussing with microbiology, an alternative may be:

Clindamycin 600mg every 8 hours orally

 

Contaminated infection recommendation

Contaminated infectionTotal duration: 7 days 

Continue IV therapy for 24 hours after final washout / clinical improvement 

Antimicrobial recommendation Co-amoxiclav 1.2g every 8 hours IV
Penicillin Allergy OR Previous MRSA

Vancomycin IV use NHS Lothian Calculator located on AMT Intranet page

AND

Gentamicin IV use NHS Lothian Calculator located on AMT Intranet page

AND

Metronidazole 400mg every 8 hours orally 
IV to oral switch

Co-amoxiclav 625mg every 8 hours
Penicillin Allergy OR Previous MRSA

Doxycycline 100mg every 12 hours orally 

AND

Metronidazole 400mg every 8 hours orally

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

Clindamycin   600mg every 8 hours orally

 

Co-amoxiclav and clindamycin are associated with C.diff infection. They should be avoided in patients at risk of C.diff infection.