Cellulitis

Antimicrobial prescribing: NHS Lothian
NHS Lothian

Human and animal bite guidelines are available here.

Follow guidelines here for severe skin soft tissue infection in a person who injects drugs.

Assessment

  • Ensure elevation of affected limb.
  • Demarcate erythema on leg to help assess responses/spread.

Required Investigations

  • Would swab for bacterial culture, if there is an open would, drainage, or an obvious portal for microbial entry
  • Blood cultures (10mls per bottle) for severe cases, before starting IV antibiotics

Antimicrobial recommendation

Mild infection
Recommended total duration: 5 days (Total duration = IV + oral

Antibiotic recommendation

 

 Flucloxacillin 500mg-1g every 6 hours orally 
Penicillin allergy or previous MRSA(if MRSA check prior sensitivities)

Doxycycline 200mg first dose then 100mg every 24 hours orally
Severe infection
Recommended total duration: 7 days (Total duration = IV + oral)

Antibiotic recommendation

 

 Flucloxacillin 2g every 6 hours IV
Penicillin allergy or previous MRSA Vancomycin IV (use NHS Lothian Calculator on AMT intranet page) choose trough 10-15 mg/L

 

IV to oral switch

Antimicrobial recommendation

 

 Flucloxacillin 1g every 6 hours 

Penicillin allergy OR previous MRSA(if MRSA check prior sensitivities)

 

Doxycycline 100mg every 12 hours

 

Editorial Information

Last reviewed: 01/02/2024

Next review date: 01/02/2027

Version: 2.1

Approved By: Antimicrobial Management Committee