Minor furunculosis, folliculitis and small abscesses WITHOUT cellulitis

NO antibiotics, perform incision and drainage if necessary

Wound infections with minor/moderate cellulitis including facial cellulitis

Oral flucloxacillin 500mg 4 times daily (minor/mild infection)

Oral flucloxacillin 1g 4 times daily (moderate infection)

5 days and review.  Up to 7 days depending on severity of illness.

See duration note above.

Wound infections with minor/moderate cellulitis including facial cellulitis

Penicillin allergy or if MRSA suspected (unlicensed indication)

Oral doxycycline 100g twice daily

5 days and review.  Up to 7 days depending on severity of illness.

See duration above.

Wound infections with minor/moderate cellulitis including facial cellulitis

If dirty/penetrating wound

Ensure surgical washout and assess tetanus immunisation status.

See advice early if peri-orbital cellulitis suspected.

ADD oral metronidazole 400mg 3 times daily

5 days and review.  Up to 7 days depending on severity of illness.

See duration note above.

See: Vaccines and antisera (Formulary)

Major cellulitis or wound infection with gross contamination or in IV drug user

IV flucloxacillin 1 to 2g 4 times daily

Up to 14 days - rationalise to oral route when responding

Major cellulitis or wound infection with gross contamination or in IV drug user

If penicillin allergy or if MRSA suspected

IV vancomycin - refer to NHS Highland vancomycin dosing guidelines

Up to 14 days depending on severity of illness.  Rationalise to oral route when responding.

Major cellulitis or wound infection with gross contamination or in IV drug user

If dirty/penetrating wound

ADD IV gentamicin (refer to NHS Highland gentamicin dosing guidelines) PLUS oral metronidazole 400mg 3 times daily OR IV metronidazole 500mg 3 times daily (if nil by mouth)

Up to 14 days depending on severity of illness.  Rationalise to oral route when responding.

Wound infections associated with fresh or salt water contamination 

Seek advice from Microbiology

Orbital cellulitis

IV ceftriaxone 2g once daily

7 days. Seek advice and refer to Ophthalmologist.

Post caesarean section wound infection. Infection often polymicrobial

Co-amoxiclav 625mg 3 times daily 

7 days

Post caesarean section wound infection

If penicillin allergy

Seek advice from Microbiology