First line:

Flucloxacillin oral 250-500 mg 6 hourly

If true penicillin / beta-lactam allergy:

Clarithromycin oral 250-500mg 12 hourly

N.B. Clarithromycin should not be prescribed concurrently with ciclosporin, sirolimus or tacrolimus.

If suspected MRSA:

Doxycycline oral 200mg as a STAT dose, followed by 100mg 12 hourly

N.B. In pregnant patients, doxycycline is contraindicated.

Severe infection:

Use guidance for limb cellulitis.

If infection is very severe and accompanied by septic shock, treat as necrotising fasciitis.

• 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.