Skin Infections (antibacterial therapy) Flashcards
What is the initial treatment of localised Impetigo for patients who are NOT systemically unwell?
- Hydrogen peroxide 1%:
Apply 2-3 times a day for up to 3 weeks
If unsuitable, offer a topical antibacterial:
- Fusidic acid
Apply to skin 3 times a day for 5-7 days
If Fusidic acid resistance:
- Mupirocin
Apply to skin 3 times a day for 5-7 days
What treatments should be given to patients with widespread non-bullous impetigo who are NOT systemically unwell or at high risk of complications?
Flucloxacillin:
- 500 mg PO 4 times a day for 5 days
Or, if penicillin allergic
Clarithromycin:
- 250 mg PO BD for 5 days
Or, if pregnant
Erythromycin:
- 500 mg by mouth 4 times a day for 5-7 days
What treatments should be given to patients with widespread non-bullous impetigo who are NOT systemically unwell or at high risk of complications, and would prefer a topical treatment?
Hydrogen peroxide 1%:
- 2-3 times a day for 5 days
Fusidic acid 2%:
- 3 times a day for 5 days
What treatments should be given to patients with non-bullous Impetigo who ARE systemically unwell or at high risk of complications and in all patients with bullous Impetigo?
Flucloxacillin:
- 500 mg PO 4 times a day for 5 days
Or if penicillin allergic
Clarithromycin:
- 250 mg PO BD for 5 days
Or, if pregnant
Erythromycin:
- 500 mg by mouth 4 times a day for 5-7 days
What treatments should be given to patients with non-bullous Impetigo who ARE systemically unwell or at high risk of complications and are immunocompromised?
Flocloxacillin:
- 250-500 mg every 6 hours IV
What are the cautions for prescribing Hydrogen peroxide 1% (3)
- Do not use near eyes
- Avoid on healthy skin
- Incompatible with products containing iodine or potassium permanganate.
What are the general management for treating Cellulitis and Erysipelas before starting antibacterial treatment? (3)
- Swab for microbiology testing ONLY if skin is broken
- Monitor progress before initiating antibacterial treatment by drawing around the extent of infection
- Manage any underlying condition, e.g Diabetes Mellitus, eczema, oedema, and venous insufficiency
What is the 1st line treatment for Cellulitis and Erysipelas?
(IV or PO)
Flucloxacillin:
- 0.5-1 g PO 4 times a day for 5-7 days then review
- 1-2 g IV every 6 hours
Or if penicillin allergic
Clarithromycin:
- 500 mg PO BD for 5-7 days then review
- 500 mg IV every 12 hours
Or, if pregnant
Erythromycin:
- 500 mg PO 4 times a day for 5-7 days then review
Oral Doxcycline:
- 200 mg PO initially daily for 1 dose, then maintenance 100 mg once daily for 7 days in total, then review
What is the 1st line treatment for Cellulitis and Erysipelas if the infection is near the eyes or nose?
(IV or PO)
Co-amoxiclav:
- 500/125 mg PO every 8 hrs for 7 days, then review
- 1.2 g IV every 8 hours
or
Clarithromycin:
- 500 mg PO BD for 5-7 days, then review
- 500 mg IV every 12 hours
WITH
Metronidazole:
- 400 mg PO every 8 hrs, for 7 days then review
- 500 mg IV every 8 hrs
Alternative treatment choice for severe infection of cellulitis and erysipelas?
(Oral and IV)
Co-amoxiclav:
- 500/125 mg PO every 8 hrs for 7 days, then review
- 1.2 g IV every 8 hours
Clindamycin
- 150-300 mg PO every 6 hrs, increased if necessary up to 450 mg every 6 hours for 7 days then review
- 0.6-2.7 g IV daily in 2-4 divided doses; increased if necessary to 1.2g 4 times a day, increased dose used in life-threatening
IV Cefuroxime
- 750 mg IV every 6-8 hrs, increased if necessary up to 1.5 g every 6-8 hrs
IV Ceftriaxone
- 2 g IV OD
If a patient presenting with Cellulitis and Erysipelas presents, and they have MRSA, what should be the alternative treatment choice?
ADD:
Vancomycin:
- 15-20 mg/kg IV every 8-12 hrs (max. per dose 2 g)
or
Teicoplanin
- 6 mg/kg IV every 12 hrs for 3 doses, then 6 mg/kg once daily
or
Linezoid (specialist only):
- 600 mg every 12 hrs PO or IV
What is the FIRST line oral choice for the treatment of a leg ulcer in non-severely unwell patients?
Flucloxacillin:
- 0.5-1 g PO 4 times a day for 7 days
Alt in penicillin allergy:
Doxycycline:
- 200mg daily for 1 dose initially, then maintenance 100 mg OD for 7 days in total
OR
Clarithromycin:
- 500 mg PO BD for 7 days
If pregnant!
Erythromycin:
- 500 mg PO 4 times a day for 7 days
What is the SECOND line oral choice for the treatment of a leg ulcer in non-severely unwell patients?
Co-amoxiclav:
- 500/125 mg PO every 8 hrs for 7 days
Alt in penicillin allergy:
Co-trimoxazole:
- 960 mg PO BD for 7 days
What is the FIRST line oral or IV choice for the treatment of a leg ulcer in severely unwell patients?
Flucloxacillin:
- 0.5-1 g PO 4 times a day for 7 days
- 1-2 g IV every 6 hours
with or without
Gentamicin:
- 5-7 mg/kg IV OD initially, then next doses based on
serum gentamicin concentration
and/or
Metronidazole:
- 400 mg PO every 8 hrs
- 500 mg IV every 8 hrs
OR
Co-amoxiclav:
- 500/125 mg PO every 8 hrs for 7 days
- 1.2 g IV every 8 hrs
with or without
Gentamicin:
- 5-7 mg/kg IV OD initially, then next doses based on
serum gentamicin concentration
What is the SECOND line oral or IV choice for the treatment of a leg ulcer in severely unwell patients?
Piperacillin with Tazobactam:
- 4.5 g every 8 hrs
- Increased if necessary to 4.5 g every 6 hrs, increased frequency may be used for severe infections.
