Skin and Soft Tissue Infections

Question 1

Which antibiotics would you give for mild soft tissue infection?

What if the patient had a true penicillin allergy?

For how long?

Answer 1

Oral flucloxacillin

In penicillin allergy: oral doxycycline OR oral clarithromycin

Duration: 7 days

Question 2

Which antibiotics would you give for mild human/animal bite, OR peri-anal soft tissue infection?

What if the patient had a true penicillin allergy?

For how long?

Answer 2

Oral co-amoxiclav

In penicillin allergy: oral doxycycline PLUS oral metronidazole

Duration: 7 days

Question 3

Which antibiotics would you give for moderate cellulitis?

What if the patient had a true penicillin allergy?

For how long?

Answer 3

IV flucloxacillin

In penicillin allergy: IV vancomycin

Duration: 10 days

Question 4

Which antibiotics would you give for severe or rapidly progressing cellulitis?

What if the patient had a true penicillin allergy?

For how long?

Answer 4

IV flucloxacillin, PLUS
IV gentamicin, PLUS
IV clindamycin

In penicillin allergy: replace flucloxacillin with IV vancomycin

Duration: 10 days

Question 5

Which antibiotics would you give for severe human/animal bites, or severe peri-anal infection?

What if the patient had a true penicillin allergy?

For how long?

Answer 5

IV co-amoxiclav

In penicillin allergy: IV metronidazole PLUS IV clarithromycin PLUS IV gentamicin

Duration: 10 days

Question 6

Which antibiotics would you give for suspected necrotising fasciitis?

What if the patient had a true penicillin allergy?

For how long?

Answer 6

IV flucloxacillin, PLUS
IV benzylpenicillin, PLUS
IV gentamicin, PLUS
IV clindamycin, PLUS
IV metronidazole 

In penicillin allergy: replace fluclox and benzylpenicillin with IV vancomycin

As per microbiology advice - discuss with microbiology at 48 hours