Infection
Infected chronic wounds, including arterial or venous leg ulcers
Antibiotic Therapy (before prescribing, carefully read the Notes / Comments section below)

First line:

Flucloxacillin oral 250-500 mg 6 hourly

If true penicillin / beta-lactam allergy or suspected MRSA:

Doxycycline oral 200mg stat, then 100mg once daily

N.B. In pregnant patients, doxycycline is contraindicated. See here for an alternative option in penicillin allergic pregnant patients. If pregnant with suspected MRSA, discuss with a microbiologist.

Severe infection:

Use guidance for limb cellulitis.

If infection is very severe and accompanied by septic shock, treat as necrotising fasciitis.
Duration
7 days (up to 14 days if slow response to treatment)
Notes / Comments
  • Do not swab ulcers routinely, but only if clinical signs of infection are present. Clean the ulcer with tap water or saline first and remove unhealthy tissue, then swab.
  • Chronic wounds are colonised with a number of bacterial organisms. A positive swab culture alone is not indicative of infection.
  • Treat only if signs of infection are present, such as increased oozing, worsening pain, an increase in size of the ulcer or cellulitis affecting the skin >2cm around the ulcerated area.
  • In the absence of signs of infection antibiotics will not speed up healing, but promote antimicrobial resistance development.  

 

 

Guideline reviewed February 2025
Page updated April 2025



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