Antibiotic Guideline for the Empirical treatment of sepsis

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Antibiotic Guideline for the Empirical Treatment of Sepsis:

Cellulitis:

Therapy is usually directed at Streptococcus pyogenes (Group A Strep.) and Staphylococcus aureus.

Mild cellulitis, patient not systemically unwell:

Flucloxacillin PO 500mg-1g qds (not if known/likely MRSA infection) for 7 days
If patient is penicillin allergic: Clarithromycin PO 500mg bd for 7 days

When more severe of failed adequate doses of oral flucloxacillin:

Community acquired

Flucloxacillin IV 2g qds (covers both S.aureus and S.pyogenes).
Changing to oral Flucloxacillin when cellulitis receding and systemically stable. Review need for IV antibiotics at 48 hours with microbiology results see IV-PO switch guideline.
Pencillin allergy: Clindamycin PO 450-600mg qds or IV 600mg qds if vomiting (change to oral when medically stable)
Total duration of treatment 5-7 days

Hospital acquired or where MRSA is a possibility

Vancomycin IV 1g bd (If mild renal impairment or age >65, reduce frequency to 1g od, monitor levels

Notes

If rapidly progressing cellulitis with shock, please discuss with a microbiologist as the possibility of deeper infection particularly necrotising fasciitis should be considered, which is a medical and surgical emergency and modification of the antibiotic therapy maybe required.

Unresponsive infection may be due to another diagnosis eg varicose eczema, where a dermatology opinion may be appropriate.

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Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.