Cellulitis - Soft tissue including Trauma and Bursitis

  • Click here for the OutPatient Antimicrobial Therapy (OPAT) Cellulitis guideline (Ambulatory Day Unit only)

 

Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)

A

Minor to moderate infection

Review doses in renal impairment

FLUCLOXACILLIN 1g po qds

 If suspected/confirmed MRSA, use:

DOXYCYCLINE 200mg po od

CLINDAMYCIN 450mg po qds
STOP and review if patient develops diarrhoea

 If suspected/confirmed MRSA, use:

DOXYCYCLINE 200mg po od

B

Moderate to severe infection

Review doses in renal impairment

FLUCLOXACILLIN monotherapy 2g iv qds

 If suspected/confirmed MRSA use:

TEICOPLANIN monotherapy iv every 12 hours for 4 doses then once daily.

Dose

<50kg: 400mg

50-74kg: 600mg

75-100kg:800mg

>100kg: 1000mg 

Maintain treatment pending pre-dose (trough) level on Day 5. Target level 15-60mg/L. (Click for dosing table)

For traumatic wounds assess tetanus immune status. Consider adding:

METRONIDAZOLE 400mg po tds or 500mg iv tds

CLINDAMYCIN 1.2g IV qds
STOP and review if patient develops diarrhoea

 If suspected/confirmed MRSA use:

TEICOPLANIN monotherapy iv every 12 hours for 4 doses then once daily.

Dose

<50kg: 400mg

50-74kg: 600mg

75-100kg:800mg

>100kg: 1000mg 

Maintain treatment pending pre-dose (trough) level on Day 5. Target level 15-60mg/L. (Click for dosing table)

For traumatic wounds assess tetanus immune status. Consider adding:

METRONIDAZOLE 400mg po tds or 500mg iv tds unless using Clindamycin

C

Severe life threatening infection

Review doses in renal impairment

 FLUCLOXACILLIN 2g iv qds
plus
CLINDAMYCIN 1.2g iv qds
STOP and review if patient develops diarrhoea

If suspected/confirmed MRSA, ADD:

TEICOPLANIN  iv every 12 hours for 4 doses then once daily.

Dose

<50kg: 400mg

50-74kg: 600mg

75-100kg:800mg

>100kg: 1000mg 

Maintain treatment pending pre-dose (trough) level on Day 5. Target level 15-60mg/L. (Click for dosing table)

 Urgently review with microbiologist.

 

CLINDAMYCIN 1.2g iv qds
STOP and review if patient develops diarrhoea

 If suspected/confirmed MRSA, initially ADD:

TEICOPLANIN  iv every 12 hours for 4 doses then once daily.

Dose

<50kg: 400mg

50-74kg: 600mg

75-100kg:800mg

>100kg: 1000mg 

Maintain treatment pending pre-dose (trough) level on Day 5. Target level 15-60mg/L. (Click for dosing table)

Urgently review with microbiologist.

 

 

IV to Oral Switch(explanatory notes)

As in Schedule A
Duration: Total duration of 7 days therapy and then review

 OPAT

 If patients are suitable for OPAT then they should be changed to once daily IV antibiotics: refer to the Cellulitis - Outpatient Antibiotic Therapy (OPAT) guideline for Class 2 infection - IV antibiotic options

Last Reviewed: 19/08/2015

For guidance on the administration of intravenous antibiotics
click here (GHNHSFT intranet only)