Cellulitis/Wound Infections

Cellulitis
CKS

Minor furunculosis, folliculitis and small abscesses WITHOUT cellulitis

NO antibiotics, perform incision and drainage if necessary

Wound infections with minor/moderate cellulitis including facial cellulitis

Minor infection

Oral flucloxacillin 500mg 4 times daily

7-14 days depending on severity of illness

Wound infections with minor/moderate cellulitis including facial cellulitis

Moderate infection

Oral flucloxacillin 1g 4 times daily

7-14 days depending on severity of illness

Wound infections with minor/moderate cellulitis including facial cellulitis

Penicillin allergy or if MRSA suspected (unlicensed indication)

Oral doxycycline 100mg twice daily

7-14 days depending on severity of illness

Wound infections with minor/moderate cellulitis including facial cellulitis

If dirty/ penetrating wound

ADD Oral metronidazole 400mg 3 times daily

7-14 days depending on severity of illness.
If the infection is responding slowly at 7 days, continue for a further 7 days.

If dirty/ penetrating wound ensure surgical washout and assess tetanus immunisation status

Seek advice early if peri-orbital cellulitis suspected.

Major cellulitis or wound infection with gross contamination or in IV drug user

IV flucloxacillin 1 to 2g 4 times daily

Up to 14 days - rationalise to oral route when responding

Major cellulitis or wound infection with gross contamination or in IV drug user

If penicillin allergy or if MRSA suspected

IV vancomycin - refer to NHS Highland vancomycin dosing guidelines

7-14 days depending on severity of illness.

Major cellulitis or wound infection with gross contamination or in IV drug user

If dirty/ penetrating wound

ADD IV gentamicin - refer to NHS Highland gentamicin dosing guidelines
AND IV metronidazole 500mg 3 times daily

7-14 days depending on severity of illness.

Would infections associated with fresh or salt water contamination 

Seek advice from Microbiology

Orbital cellulitis

IV ceftriaxone 2g once daily

7 days. Seek advice and refer to Ophthalmologist

Post caesarean section wound infection. Infection often polymicrobial

Co-amoxiclav 625mg 3 times daily 

7 days

Post caesarean section wound infection

If penicillin allergy:

Seek advice from Microbiology

Editorial Information

Last reviewed: 23 May 2019

Next review: 30 May 2022

Author(s): Antimicrobial management team

Approved By: TAM subgroup of ADTC

Reviewer Name(s): Area Antimicrobial Pharmacist

Document Id: AMT163