Antimicrobial prescribing: NHS Borders
Flucloxacillin oral 1g every 6 hours
Penicillin allergy or previous MRSA (if MRSA check previous sensitivities)
Doxycycline oral 200mg first dose then 100mg every 24 hours
Or
Clarithromycin oral 500mg every 12 hours
Cellulitis
Warning
What's new / Latest updates
Removal of class I-IV classification
Cellulitis
Previous microbiology results should be checked to exclude relevant resistances. MRSA carriage will affect antibiotic choice.
If a history of unusual exposure, consider discussion with Microbiology.
Consider discussion with Microbiology if no response to initial treatment.
See separate guideline for diabetic foot infections, bites and cellulitis in lymphoedema
This guidance also applies in people who inject drugs.
Fluroquinolones
Refer to important safety information for all quinolones prior to prescribing.
See MHRA Drug Safety Update January 2024: Fluoroquinolones must only be used in situations when other antibiotics, that are commonly recommended for the infection, are inappropriate such as:
- there is resistance to other first-line antibiotics recommended for the infection
- other first-line antibiotics are contraindicated in an individual patient
- other first-line antibiotics have caused side effects in the patient requiring treatment to be stopped
- treatment with other first-line antibiotics has failed
Required Investigations
- Blood cultures for severe cases, before starting IV antibiotics where possible
- Swabs from broken, exuding or ulcerated areas
- Throat swabs from patients with necrotising fasciitis
- MRDA screening as per policy
Antimicrobial Recommendation
Length of treatment
7-14 days usually with appropriate IV to oral switch. Longer courses may be required.
Consider necrotising fasciitis if severe.
Flucloxacillin IV 2g every 6 hours
Penicillin allergy or previous MRSA
Vancomycin (according to vancomycin dosing guidelines)
Flucloxacillin oral 1g every 6 hours
Penicillin allergy or previous MRSA (if MRSA check previous sensitivities)
Doxycycline oral 100mg every 12 hours
Or
Clarithromycin oral 500mg every 12 hours
Patients with abdominal wall cellulitis thought likely to originate from underlying GI pathology.
Flucloxacillin IV 2g 6 hourly
+
Ciprofloxacin IV 400mg 12 hourly (IV for first dose then review if appropriate to switch patient to oral)
+
Metronidazole IV 500mg 8 hourly or, if oral route available, 400mg oral 8 hourly
Penicillin allergy
Vancomycin (according to vancomycin dosing guideline)
+
Ciprofloxacin IV 400mg 12 hourly (IV for first dose then review if appropriate to switch patient to oral)
+
Metronidazole IV 500mg 8 hourly or, if oral route available, 400mg oral 8 hourly