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.
Best practice guidance: poster, presentation
Wound swabs SHOULD NOT be taken routinely or from an uninfected wound
Wound swabs CANNOT be used to diagnose and/or exclude infection.
Results need to be reviewed in context of the clinical picture
Refer to: Hospital: Paediatrics (Skin and Soft Tissue Infection - Cellulitis)
Flucloxacillin dose
Penicillin Allergy or Known MRSA#: Doxycycline dose (Pregnant: Clarithromycin dose)
Duration: 5 days; up to 10-14 days may be required if severe/extensive/slow to respond
Facial infection, not requiring admission
Co-Amoxiclav dose
Penicillin Allergy or Known MRSA#: Doxycycline dose + Metronidazole dose (Pregnant: Clarithromycin dose + Metronidazole dose)
Duration: 7 days
Reserve topical antibiotics for very localised lesions.
Topical Fusidic Acid 2% cream can be prescribed in community pharmacies via Pharmacy First for adults/children in minor/localised, uncomplicated cases.
Minor/localised: topical Fusidic Acid 2% dose
Severe/extensive or bullous: Flucloxacillin dose
Penicillin Allergy or MRSA suspected#: Doxycycline (Pregnant: Clarithromycin) dose
Duration: 5 days
Advise on self-care management strategies to reduce recurrence.
Topical clotrimazole 1% dose, miconazole 2% dose or terbinafine 1% dose cream
Marked inflammation: Add topical hydrocortisone 1% (BD, up to 7 days)
Duration: consult selected product literature
Refer to:
Confirm with nail clippings prior to treatment.
Offer oral antifungal if confirmed fungal nail infection and self-care measures alone and/or topical treatment are not successful or appropriate.
Terbinafine dose
Duration:
Refer to: NICE / CKS Fungal nail infection
Refer to: Hospital: Paediatrics (Skin and Soft Tissue Infection - Human / Animal bite)
Assess type and severity (incl. causative animal), wound depth and site, and whether it is infected or not. Consider need for antibiotic prophylaxis, as per NICE guidance.
Assess tetanus and rabies risk.
For human bites assess HIV and hepatitis risk.
Send a wound swab for culture if discharge is present (purulent or non-purulent). To ensure appropriate laboratory testing, clinical details must state this is a human / animal bite (detail which animal).
Co-amoxiclav dose
Penicillin Allergy: Doxycycline dose + Metronidazole dose (Pregnant: discuss with Microbiology)
Duration:
Antibiotic therapy is to treat infection, NOT heal ulcers / wounds.
Do NOT use wound swabs to diagnose infection - wound infection is a clinical diagnosis (see IWII 2022 Wound Infection Continuum: Diagnosis of Wound Infection).
Do NOT routinely culture uninfected wounds.
Wound Swabs (how to swab) / bone culture samples should be obtained prior to initiation of antibiotic therapy. Clinical details should include "diabetes" to ensure appropriate laboratory testing.
Determine severity of wound infection (mild/moderate/severe*), as per IWGDF/IDSA Infection guideline, to determine most appropriate antibiotic therapy.
Follow Acute Foot Deterioration in a Patient Living with Diabetes Pathway. Consider referral to Diabetes Foot Clinic.
Flucloxacillin dose
Penicillin Allergy or Known MRSA# or Non-antibiotic naïve: Doxycycline dose
Duration: 7 days
Consider need for Secondary Care assessment (e.g. surgical input required). If no complicating factors, likely can be manged in Primary care with oral antibiotics.
Co-amoxiclav dose
Penicillin Allergy or Known MRSA# or Non-antibiotic naïve: Doxycycline or Co-trimoxazole or Clindamycin dose
Duration: 7 days; may need up to 14 days if slow response. If osteomyelitis is diagnosed 4 - 6 weeks of therapy is usually indicated.
Requires hospital admission for IV antibiotics and assessment
Treat erythema migrans empirically.
Prophylactic antibiotic in the absence of signs/symptoms following a tick bite is NOT recommended.
Base need for serology testing on algorithm within the SLDTRL User Manual:
Click image for larger version / pdf.
All serology requests must include: symptoms, time between tick bite / possible exposure and onset of illness. Samples with inadequate clinical details (e.g. ?lyme, tick bite) will not be referred for testing.
For management guidance and antibiotic choice/duration, refer to NICE Lyme disease guidance.
Advise two applications one week apart.
Treat all household members and sexual contacts.
Pregnant women can be treated.
Treat entire body below ear/chin including under nails.
Include face and scalp in under 2's and elderly patients.
Permethrin 5% cream dose (adults and children >2 months)
Second line: Malathion 0.5% liquid dose (adults and children >6 months)
Refer to: NICE/CKS: Management of Scabies
Send a wound swab for culture if discharge is present (purulent or non-purulent). Include relevant clinical details.
If there is no clinical improvement on empirical therapy, consider adjusting antibiotics according to swab results.
Do NOT use wound swabs to diagnose infection - wound infection is a clinical diagnosis (see IWII 2022 Wound Infection Continuum: Diagnosis of Wound Infection).
Flucloxacillin dose
Penicillin Allergy or Known MRSA#: Doxycycline dose (Pregnant or Breast Feeding: Clarithromycin dose) Duration: 5 - 7 days
PLEASE REFER TO Obstetrics and Gynaecology Antimicrobial Formulary
Advise women to continue breastfeeding, including from affected breast if possible.
Encourage simple analgesia for pain/discomfort.
Send breast milk sample for culture in cases of treatment failure.
Identify and manage predisposing factors e.g. breastfeeding problems - refer health visitor or NHS breastfeeding support.
Flucloxacillin dose
Penicillin Allergy or Known MRSA#: Clarithromycin dose or Co-trimoxazole*dose
No improvement after 48 hours, and hospital admission is not required
Co-amoxiclav dose
Penicillin Allergy or Known MRSA#: Clarithromycin dose (or Co-trimoxazole*,dose) + Metronidazole dose
* Avoid during pregnancy and whilst breastfeeding: in the first 6 weeks after birth, where there is a possibility of G6PD deficiency, or if baby is jaundiced. Seek Microbiology advice.Duration: 7 - 14 days, depending on severity and response
Refer to: NICE Mastitis and Breast Abscess
NHS Dumfries & Galloway Antimicrobial Handbook
