Leg Ulcer / Wound (Non-Diabetic)
Antimicrobial prescribing: NHS Forth Valley
Antibiotics do not improve healing unless active infection. (e.g. purulent exudate, spreading erythema)
Do not routinely swab ulcers and wounds.
Use the NHS FV - "SHOULD I SWAB THIS WOUND?" POSTER to guide when and how to take a microbiology sample and interpret the results.
See Wound Management Guidelines and Formulary. (Page 71: Algorithm for assessment and management of chronic wounds)
Further information on wound assessment including a visual guide can be found here
Chronic ulcers and wound will always be colonised with bacteria e.g. Staph, coliforms (e.g. E coli, Proteus), Pseudomonas, anaerobes and possibly yeast too.
Presence of organism(s) on a swab is not an indication in itself of infection or requirement for antibiotic therapy.
Effective chronic wound care is essential for healing and avoidance of recurrent infection.
Drug details
Flucloxacillin
500mg - 1g QDS
5-7 days
Penicillin allergy:
Doxycycline
200mg STAT followed by 100mg OD
5-7 days
Second Line:
Co-trimoxazole
960mg BD
5-7 days
If the infection is responding to antibiotic therapy but only slowly responding, review the patient after 7 days and consider continuing the antibiotic for a further 7 days.