Wound infections

Surgical wounds, abscesses and wound infection
Flucloxacillin
Flucloxacillin 500mg capsules

500mg every 6 hours for 7 days

Flucloxacillin 250mg/5ml oral solution sugar free

500mg every 6 hours for 7 days

If allergic to penicillin

Doxycycline
Doxycycline 100mg capsules

200mg on day 1, then 100mg daily for 7 days in total

Prescribing Notes:

  • Flucloxacillin has adequate streptococcal cover; therefore it is not necessary to prescribe penicillin in addition, for empirical treatment of non-severe cellulitis. If there has been exposure to river or sea water, discuss treatment with a microbiologist.
  • All wounds have potential for bacterial infection and may become colonised but swabs should only be taken if there are clinical signs of infection.
  • Prescription of antibiotics should not delay appropriate surgical management e.g. drainage or aspiration of an abscess.
  • See also Wound Management section of the formulary.

History Notes

15/12/2021

East Region Formulary content agreed.

MRSA soft tissue infections (moderate/severe)

Choice of treatment depends upon the extent of infection and sensitivity result for the MRSA isolated from patient.

Doxycycline
Doxycycline 100mg capsules

100mg every 12 hours for 5 days

Prescribing Notes:

  • MRSA, like other Staphylococcus aureus strains, may be part of normal colonising flora, for example, on skin, on a leg ulcer, in urine in an asymptomatic catheterised patient. The criteria for treating MRSA are the same as for any other pathogen, i.e. clinical evidence of chest infection, soft tissue infection, or systemic illness in a catheterised patient.
  • Check sensitivities, if possible before starting systemic antibiotics.
  • Most MRSA locally is sensitive to doxycycline.
  • If severe infection or no response to monotherapy after 24-48 hours, seek advice from Microbiology.

History Notes

15/12/2021

East Region Formulary content agreed.

Surgical wounds, abscesses and wound infection
Flucloxacillin
Flucloxacillin 500mg capsules

Refer to BNFc for dose and duration.

Flucloxacillin 250mg capsules

Refer to BNFc for dose and duration.

Flucloxacillin 125mg/5ml oral solution sugar free

Refer to BNFc for dose and duration.

Flucloxacillin 250mg/5ml oral solution sugar free

Refer to BNFc for dose and duration.

If allergic to penicillin.

Clarithromycin
Clarithromycin 250mg tablets

For dose and duration see BNFc.

Clarithromycin 500mg tablets

For dose and duration see BNFc.

Clarithromycin 125mg/5ml oral suspension

For dose and duration see BNFc.

Clarithromycin 250mg/5ml oral suspension

For dose and duration see BNFc.

If penicillin allergic and > 12 years an alternative is doxycycline.

Doxycycline
Doxycycline 100mg capsules

For dose and duration see BNFc.

Prescribing Notes:

  • Flucloxacillin has adequate streptococcal cover; therefore it is not necessary to prescribe penicillin in addition, for empirical treatment of non-severe cellulitis. If there has been exposure to river or sea water, discuss treatment with a microbiologist.
  • All wounds have potential for bacterial infection and may become colonised but swabs should only be taken if there are clinical signs of infection.
  • Prescription of antibiotics should not delay appropriate surgical management e.g. drainage or aspiration of an abscess.
  • See also Wound Management section of the formulary.

History Notes

15/01/2024

East Region Formulary content agreed.

MRSA soft tissue infections (moderate/severe)

Choice of treatment depends upon the extent of infection and sensitivity result for the MRSA isolated from patient.

Prescribing Notes:

  • MRSA, like other Staphylococcus aureus strains, may be part of normal colonising flora, for example, on skin, on a leg ulcer, in urine in an asymptomatic catheterised patient. The criteria for treating MRSA are the same as for any other pathogen, i.e. clinical evidence of chest infection, soft tissue infection, or systemic illness in a catheterised patient.
  • Check sensitivities, if possible before starting systemic antibiotics.
  • If severe infection or no response to monotherapy after 24-48 hours, seek advice from Microbiology.

History Notes

15/01/2024

East Region Formulary content agreed.