NHSL Antimicrobial Guidelines
Important: Therapy
Oral Flucloxacillin5 500mg - 1g 6 hourly
Penicillin allergy
Oral Doxycycline2, 9 100mg 12 hourly
OR
Oral Co-trimoxazole 2,10,12,13 960mg 12 hourly
Notes:
Total duration:5 days
Cellulitis
Warning
Duration
Mild-Moderate Cellulitis: 5 days
Moderate to Severe Cellulitis/Erysipelas: IV / oral 7-14 days depending on clinical progress
Important: Therapy
IV Flucloxacillin5, 10 1-2g 6 hourly
Stepping down to:
Oral Flucloxacillin 1g 6 hourly
Penicillin allergy or MRSA suspected
IV Vancomycin3
Stepping down to:
Oral Doxycycline2,9 100mg 12 hourly
Notes:
For upper limb cellulitis seek advice from Orthopaedics
Total duration: IV / oral 7-14 days depending on clinical progress
Important: Notes
Doses may need to be adjusted in renal impairment. Always check the BNF for interactions. Seek advice if patient pregnant.
Drug Specific Cautions:
- Check interactions in the BNF. Caution may prolong QT interval.
- Avoid / Caution in pregnancy or breastfeeding. Consult BNF for details.
- Gentamicin/Vancomycin refer to online calculators.
- ALERT Antibiotic - Consult Second line Policy on NHS Lanarkshire Guideline App.
- Monitor sodium.
- See CURB65 definition.
- Reference: The Renal Drug Handbook. Online access.
- See Fluoroquinolones MHRA guidance on NHS Lanarkshire Guidelines App.
- Doxycycline and quinolones decreased absorption with iron, calcium, magnesium and some nutritional supplements. See BNF appendix 1 or pharmacy for advice.
- Caution in renal impairment – see BNF or pharmacy for advice.
- Use with caution may increase K+ and decrease renal function. Monitor.
- High / Excellent oral bioavailability, IV route available for NBM or vomiting.
- See Co-trimoxazole information for prescribers’ safety sheet on NHS Lanarkshire Guidelines App.