Pre-Septal Cellulitis
Causative organisms: Staphyloccus aureus, Streptococci
|
First Line |
Second Line |
Third line if patient is suspected or confirmed MRSA colonisation |
Allergy status
(Confirm allergy status prior to choosing antimicrobial regime) |
No penicillin allergy |
|
|
Antimicrobial
Check for interactions |
Amoxicillin
and
Flucloxacillin |
Clarithromycin |
Doxycycline (mild cases)
OR
Teicoplanin (severe cases) OR
Linezolid (severe cases) |
Dose |
Amoxicillin 500mg every 8 hours
and
Flucloxacillin 500mg every 6 hours |
Clarithromycin
500mg every 12 hours |
Mild cases:
Doxycycline 200mg STAT and then 100mg every 12 hours
OR
Severe cases:
Teicoplanin loading dose = 12mg/kg every 12 hours for 2 days
OR
Linezolid 600mg every 12 hours |
Route |
PO |
PO |
PO/IV |
Duration |
7 days |
Additional Information
- Prior to choosing antibiotic treatment, review previous microbiological results from a swab and MRSA status.
- Consider discussing with Med Micro/ID if exposure to water-borne pathogens, cellulitis related to penetrating injury, severe or non-improving soft tissue infection in a returned traveller.
- Linezolid is a reversible, non-selective monoamine oxidase inhibitor (MAOI).
- Patients should avoid consuming large amounts of tyramine-rich foods (such as mature cheese, yeast extracts, undistilled alcoholic beverages, and fermented soya bean products).
- Linezolid should not be given with another MAOI or within 2 weeks of stopping another MAOI.
- Unless close observation and blood-pressure monitoring is possible, avoid in those receiving SSRIs, 5HT1 agonists (‘triptans’), tricyclic antidepressants, sympathomimetics, dopaminergics, buspirone, pethidine and possibly other opioid analgesics due to the risk of serotonin syndrome.
- Contact pharmacy for advice on the management of drug interactions with linezolid.
- FBC must be monitored weekly during linezolid therapy due to risk of blood disorders.
Doxycycline is ineffective if given with multi-valent cation containing products e.g. antacids, supplements or feeds containing calcium, iron, magnesium, zinc, sucralfate or bismuth. These products bind to doxycycline and reduce its absorption by up to 90%.
If patients are prescribed antacids or supplements containing calcium iron, magnesium zinc or bismuth. It is advised these medications are stopped/withheld for the duration of antibiotic treatment. If this is not possible due to a clinical need, then an alternative antibiotic must be considered
If doxycycline and a cation containing product must be prescribed together:
· Administration times should be as far apart as possible
· Reduce the dosing frequency of the interacting product if possible
· In the case of oral nutritional supplements, multiple sips throughout the day should be replaced with set administration times to enable adequate spacing from oral antibiotic administration
· If a patient is receiving an enteral feed doxycycline should generally be avoided unless there is a specific feed free window