For skin and soft tissue infections requiring intravenous therapy, consider referral to the Out-patient Parenteral Antibiotic Therapy Service (OPAT) if able to attend the Raigmore OPAT centre daily.  Refer to the OPAT website for the SSTI pathway and referral form.

As resistance is increasing reserve topical antibiotics for very localised lesions.  For minor infections and impetigo only and where Emulsiderm^® will not suffice, topical sodium fusidate 2% ointment can be used for a maximum of 10 days treatment.  For extensive, severe or bullous impetigo, use oral antibiotics.

For paediatric patients, please refer to the current edition of BNF for Children for drug doses.

For zoonotic infections (eg associated with animals or fish), seek advice from Microbiology or Infectious Disease Physician as the causative pathogens may differ.

For the management of cellulitis in a lymphoedema patient, refer to the Lymphoedema section in Therapeutic Guidelines.

For leg ulcers: these are almost always colonised and antibiotics do not improve healing unless there is active infection.  Cleanse the wound with tap water or sodium chloride 0.9% to remove surface contaminants.  Remove slough and necrotic tissue. Swab viable tissue displaying signs of infection (cellulitis/increased pain/pyrexia/purulent exudate/odour).  Treat empirically as per cellulitis guidance and review with swab results. 

Gentamicin therapy must be reviewed at 48 to 72 hours and continued on specialist advice only.

DO NOT SUTURE BITE WOUNDS
Antibiotic prophylaxis is advised if aged over 50 years, cat bite/puncture wound, bite to hand, foot, face, joint, tendon, ligament; immunocompromised / diabetic / asplenic / cirrhotic / presence of prosthetic valve or prosthetic joint.
Assess rabies risk (animal bite); assess risk of blood borne virus transmission (human or primate bite).
Consider hepatitis B vaccination.