Soft Tissues and Skin Infection (H@H)

Antimicrobial prescribing: NHS Lothian
NHS Lothian

Organisms:

Streptococcus pyogenes (Group A Strep) and Staphylococcus aureus

Investigations:

  • Swabs of intact skin are not recommended
  • Patients with cellulitis are rarely bacteraemic
  • Review if the patient has been previously colonised with MRSA
  • Patients with penicillin allergy tend to have more resistant organisms – review previous results
  • Coliforms (Gram negative bacilli) and Pseudomonas in swabs from ulcers normally only reflect colonisation and antibiotics should not be used to target these isolates.

Use the The Scottish Ropper Ladder (also see Appendix 3) to identify patients with infected wounds or ulcers, and to guide management

Cellulitis (H@H)

Length of treatment: 5 days

First choice:

Flucloxacillin 1g orally every 6 hours

Reduce dose to 500mg every 6 hours when reduced compliance likely with 1g doses.

Penicillin allergy:

Doxycycline 200mg orally on day 1, then 100mg daily every 24 hours

Severe infection:

Consider admitting to hospital.  Group A Streptococcus can cause a rapidly progressing severe infection

Teicoplanin intravenous (see Appendix 2 for protocol)

Diabetic foot ulcer should be referred for ongoing community diabetic foot specialist care or to the hospital team, as appropriate.