Cellulitis/Wound Infections (Antimicrobial)
TAM (Treatments and Medicines) NHS Highland
What's new / Latest updates
05/07/24 - section reviewed. Duration amended.
Cellulitis CKS
See also: SKIN & SOFT TISSUE (Antimicrobial) on use of skin and soft tissue pathway (SSTI).
Assess suitability for out-patient IV antibiotics to avoid admission or support early discharge.
For skin and soft tissue infections requiring intravenous therapy, consider referral to the Out-patient Parenteral Antibiotic Therapy Service (OPAT).
- Refer to the OPAT website for the SSTI pathway and referral form. (NHS Highland intranet access required).
Duration for mild to moderate infection: if the infection is responding slowly at 7 days, continue for a further 7 days.
Drug details
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.
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