SKIN AND SOFT TISSUE First choice Ongoing management / MINIMUM INFECTION Most likely causal organisms duration of antibiotic therapy [acceptable alternative] Staph. aureus If mild/moderate infection, oral cefalexin or oral co- 7 days amoxiclav. [Clarithromycin if confirmed penicillin allergy] Group A streptococcus (may have oral switch) Group G streptococcus Consider ambulation and daily review on If severe infection:- ceftriaxone IV (+- metronidazole po) Consider streptococci α-haemolytic ceftriaxone IV [if severe penicillin allergy, use clindamycin] or anaerobes if facial cellulitis Oral Add metronidazole if facial cellulitis (see ophthalmology Cellulitis If recurrent or severe Staph aureus Cefalexin or co-amoxiclav section for periorbital cellulitis) infection, consider PVL testing. or [Clarithromycin if penicillin allergy] Add clindamycin if associated sepsis / signs of toxin mediated disease (risk factors include chickenpox or burns). or co-amoxiclav for facial cellulitis Consider IVIG 2g/kg. Provide safety netting information (verbal and written) prior to discharge. If mild/moderate infection, use oral cefalexin or co- Staph. aureus 5 days amoxiclav Group A streptococcus (may have oral switch) [clarithromycin if confirmed penicillin allergy] Oral options cefalexin or co-amoxiclav – If severe infection, use ceftriaxone IV [if severe penicillin Impetigo allergy, use clindamycin] or [clarithromycin if penicillin allergy] Optimisation of topical steroids is the mainstay of treatment in these patients.
SKIN AND SOFT TISSUE INFECTION Most likely causal organisms First choice [acceptable alternative] Ongoing management / MINIMUM duration of antibiotic therapy Cellulitis Staph. aureus Group A streptococcus Group G streptococcus Consider α-haemolytic streptococci or anaerobes if facial cellulitis If recurrent or severe Staph aureus infection, consider PVL testing. If mild/moderate infection, oral cefalexin or oral co- amoxiclav. [Clarithromycin if confirmed penicillin allergy] If severe infection:- ceftriaxone IV [if severe penicillin allergy, use clindamycin] Add metronidazole if facial cellulitis (see ophthalmology section for periorbital cellulitis) Add clindamycin if associated sepsis / signs of toxin mediated disease (risk factors include chickenpox or burns). Consider IVIG 2g/kg. 7 days (may have oral switch) Consider ambulation and daily review on ceftriaxone IV (+- metronidazole po) Oral Cefalexin or co-amoxiclav or [Clarithromycin if penicillin allergy] or co-amoxiclav for facial cellulitis Provide safety netting information (verbal and written) prior to discharge. Impetigo Staph. aureus Group A streptococcus If mild/moderate infection, use oral cefalexin or co- amoxiclav [clarithromycin if confirmed penicillin allergy] If severe infection, use ceftriaxone IV [if severe penicillin allergy, use clindamycin] Optimisation of topical steroids is the mainstay of treatment in these patients. 5 days (may have oral switch) Oral options – cefalexin or co-amoxiclav or [clarithromycin if penicillin allergy]
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