Hospital therapy for IV antibiotics
- IV flucloxacillin 2g 6-hourly
- No/poor response after 48 hours: give clindamycin 600mg 6-hourly IV.
- Allergic to penicillin: give vancomycin IV according to NHS Highland vancomycin dosing guidelines. Seek advice from Microbiology prior to considering clindamycin 600mg 6-hourly IV
- Ano-genital cellulitis: give flucloxacillin 2g 6-hourly IV plus gentamicin 5mg/kg IV (as per NHS Highland gentamicin dosing guidelines) daily; adjust dose according to renal function and assay.
- Monitor inflammatory markers (C-Reactive Protein, Plasma Viscosity, WCC)
- Full blood count and routine biochemistry
- Monitor vital signs
- Record baseline: extent and severity of rash; consider marking and dating the edge of the erythema using a soft-tipped pen (not ballpoint)
- Blood cultures if evidence of sepsis
- Microbiology swab of skin breaks or blisters prior to starting antibiotics
- Blood glucose
- Antistreptolysin titre (ASO)
- Mycology sample if severe tinea pedis present or fungal nail infection: skin scrapping and/or nail clippings
- Provide advice on self-care
- Bed rest and elevation of the affected area/limb
- Avoid compression garments during the acute attack; use as soon as comfortable and tolerated
- Recommend analgesia, such as paracetamol; avoid NSAIDS during the acute attack (possible link to necrotizing fasciitis)
- Resume normal levels of exercise when inflammation has reduced and person is comfortable
- Return to work depends on the person’s occupation.
Switch IV to oral treatment
Flucloxacillin 500mg 6-hourly, or clindamycin 300mg 6-hourly once:
- Temperature down for 48 hours
- Inflammation has resolved
- CRP is falling.
Continue oral antibiotics for at least 14 days after a definite clinical response has been observed, and until all signs of acute inflammation have resolved.
- Some individuals require an extended period of oral antibiotic treatment
- Skin changes, discolouration or staining may persist for months or longer following severe cellulitis and do not necessarily require ongoing antibiotics
- Some individuals may require a supply of antibiotics to self-administer early