15. Skin and Soft tissue

It is essential to assess the severity of local and systemic signs and symptoms of infection, and to identify the presence of any risk factors like diabetes, neutropenia, drug abuse, human or animal bite, etc.
Antibiotic treatment can be modified based on culture results in consultation with microbiologist.

Infection	IV treatment	Oral treatment	Duration
Cellulitis Mild cases, minor systemic symptoms		Amoxicillin 500mg tds orally plus flucloxacillin 500mg qds orally If penicillin allergic, clarithromycin 500mg bd orally or clindamycin 300mg qds orally	10 days
Cellulitis Moderate and severe cases, significant systemic symptoms	Benzylpenicillin 1.2g every 4 hours plus flucloxacillin 2g qds. If penicillin allergic clindamycin 450mg qds IV or clarithromycin 500mg bd IV*	Amoxicillin 500mg tds orally plus flucloxacillin 500mg qds orally If penicillin allergic clarithromycin 500mg bd orally or clindamycin 450mg qds orally	Treat intravenously for 3-5 days or until clinical improvement. Oral therapy for 10-14 days
Group A Streptococcal cellulitis	Benzylpenicillin 1.2g every 4 hours plus clindamycin 450mg qds. If penicillin allergic clindamycin 450mg qds	Switch to oral treatment when appropriate improvement in condition. Amoxicillin 500mg tds orally PLUS clindamycin 450mg qds orally. If penicillin allergic clarithromycin 500mg bd orally or clindamycin 450mg qds orally.	Treat intravenously for 3-5 days or until clinical improvement. Oral therapy for 10-14 days
Necrotising fasciitis Life threatening infection; early Microbiology consultation and surgical intervention ESSENTIAL.	Imipenem IV 500-1000mg qds* PLUS clindamycin 450-600mg qds	Treat as advised by Microbiology	Prolonged therapy may be required
Animal and human bites	Co-amoxiclav 1.2g tds	Co-amoxiclav 375mg tds orally when appropriate. If penicillin allergic, clindamycin 450mg qds orally PLUS ciprofloxacin 500mg bd orally.	5-7 days

*For patients with renal impairment refer to section 23 for dosage adjustments