Staph. aureus Antibiotics are not generally needed if the wound is more 7 days if mild penetrating injury. than 2 days old and there is no sign of local or systemic Bacteroides spp. infection Pasteurella multocida 14 days if severe or deep penetrating injury Prescribe antibiotics for: IV antibiotics followed by oral co- Group A streptococcus (human bites) – amoxiclav. All human bite wounds under 72 hours old. All cat bites, animal bites to the hand, foot, and face; Often polymicrobial (aerobic + puncture wounds; wounds requiring surgical Consider tetanus and hepatitis B vaccine if anaerobic) debridement; wounds involving joints, tendons, ligaments, human bite. Consider tetanus or suspected fractures. immunoglobulin if animal bite in children Wounds that have undergone primary closure. with incomplete tetanus immunisation status. Children who are at risk of serious wound infection (for Bites (not insect example those who are asplenic, or bites) immunosuppressed). Children with a prosthetic valve or a prosthetic joint. If mild/moderate injury, for oral co-amoxiclav. If severe or deep penetrating, IV co-amoxiclav and clindamycin po/IV [Azithromycin and metronidazole if penicillin allergy] Do not use topical prophylactic Abs post-burns Staph. aureus 7 days (may have oral switch) Group A streptococcus If mild/moderate infection, use oral cefalexin or co- Pseudomonas aeruginosa amoxiclav Consider ambulation and daily review on Candida spp. [clarithromycin if confirmed penicillin allergy] ceftriaxone IV Secondary Oral infections following If severe infection, use ceftriaxone cefalexin or co-amoxiclav burns If know colonised with pseudomonas, for piperacillin/tacobactam (tazocin) or [clarithromycin if penicillin allergy] If signs of systemic upset and /or diarrhoea and/or spreading rash, treat as toxic shock syndrome and add IV clindamycin. Consider IVIG 2g/kg (preferable to FFP as higher antitoxin concentration)
Bites (not insect bites) Staph. aureus Bacteroides spp. Pasteurella multocida Group A streptococcus (human bites) Often polymicrobial (aerobic + anaerobic) Antibiotics are not generally needed if the wound is more than 2 days old and there is no sign of local or systemic infection Prescribe antibiotics for: All human bite wounds under 72 hours old. All cat bites, animal bites to the hand, foot, and face; puncture wounds; wounds requiring surgical debridement; wounds involving joints, tendons, ligaments, or suspected fractures. Wounds that have undergone primary closure. Children who are at risk of serious wound infection (for example those who are asplenic, or immunosuppressed). Children with a prosthetic valve or a prosthetic joint. If mild/moderate injury, for oral co-amoxiclav. If severe or deep penetrating, IV co-amoxiclav and clindamycin po/IV [Azithromycin and metronidazole if penicillin allergy] 7 days if mild penetrating injury. 14 days if severe or deep penetrating injury – IV antibiotics followed by oral co- amoxiclav. Consider tetanus and hepatitis B vaccine if human bite. Consider tetanus immunoglobulin if animal bite in children with incomplete tetanus immunisation status. Secondary infections following burns Staph. aureus Group A streptococcus Pseudomonas aeruginosa Candida spp. Do not use topical prophylactic Abs post-burns If mild/moderate infection, use oral cefalexin or co- amoxiclav [clarithromycin if confirmed penicillin allergy] If severe infection, use ceftriaxone If know colonised with pseudomonas, for piperacillin/tacobactam (tazocin) If signs of systemic upset and /or diarrhoea and/or spreading rash, treat as toxic shock syndrome and add IV clindamycin. Consider IVIG 2g/kg (preferable to FFP as higher antitoxin concentration) 7 days (may have oral switch) Consider ambulation and daily review on ceftriaxone IV Oral cefalexin or co-amoxiclav or [clarithromycin if penicillin allergy]
pier_first_line_antibiotic_guide_v_3_4_13_3_18__2_.docx