Take swabs prior to antibiotic therapy. Check previous microbiology results, allergies and drug interactions.Penicillin Allergy:
• Penicillin allergy is documented in over10% of patients but the nature of allergy is often uncertain (not a true allergy).
• True allergy (anaphylaxis) occurs in under 1% of patients and is a barrier to all beta-lactam antibiotics.
• History of a rash or mild symptoms could still allow the use of cephalosporins or carbapenem antibiotics.

Consider delayed antibiotic prescriptions.

Cellulitis

Mild/moderate cellulitis:

PO Flucloxacillin


If penicillin allergic:
PO Doxycycline
PO Doxycycline 200mg followed by 100mg BD

Duration: 5-7 days

Surgical wounds

Mild wound infection:

PO Flucloxacillin


If penicillin allergic:
PO Doxycycline
PO Doxycycline 200mg followed by 100mg BD

Duration: 5-7 days


Swab if exudate.

Diabetic foot ulcer

PO Flucloxacillin


If penicillin allergic:
PO Doxycycline 200mg followed by 100mg BD

Duration: 5-7 days

Impetigo

  • Reserve topical antibiotics for very localised lesions.


Topical Fusidic acid 2% TDS for 5 days

If more severe:flucloxacillin 500mg QDS

If penicillin allergic or MRSA suspected: Clarithromycin 500mg BD

Duration: 5-7days

Fungal infections

  • Nail: confirm with nail clippings prior to treatment. Prolonged courses of antifungals needed on confirmation.

Terbinafine 250mg OD
Hands: 6-12 weeks duration
Feet: 6 months duration
Skin: topical terbinafine BD for 7 days.

Animal or human bites

  • Assess tetanus and rabies risk.
  • For human bites assess HIV and hepatitis risk.

Non-severe bites:
PO Co-amoxiclav


If penicillin allergic:PO Doxycycline and PO Metronidazole

Duration: 5 days

Lyme disease

  • Treat erythema migrans empirically
  • Serology often negative early infection
  • Complex symptoms seek advice


PO Doxycycline 200mg followed by 100mg BD

Duration: 21 days

Chickenpox and shingles

Chickenpox:

  • Consider antiviral if patient presents within 24hrs of rash onset or immunocompromised.
  • (D/W microbiology if pregnant)

Aciclovir 800mg 5 times daily

Duration: 7 days

Shingles:

  • If presents within 72 hrs of rash onset consider antiviral or immunocompromised.

Acyclovir 800mg 5 times daily

Duration: 7 days

Scabies

  • Treat whole body below ear/chin and under nails.
  • Include face and scalp in under 2s and elderly

Permethrin 5% cream two applications 7 days apart.

Editorial Information

Last reviewed: 18/12/2023

Next review date: 18/12/2024

Reviewer name(s): J. Van Aartsen.