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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
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Check for interactions

Doxycycline (mild cases)


Teicoplanin (severe cases) OR

Linezolid (severe cases)

 Amoxicillin 500mg every 8 hours
Flucloxacillin 500mg every 6 hours
 500mg every 12 hours

Mild cases: ​

Doxycycline 200mg STAT and then 100mg every 12 hours


Severe cases:

Teicoplanin loading dose = 12mg/kg every 12 hours for 2 days
(see guidelines for maintenance dose)​
Linezolid 600mg every 12 hours
 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