Penicillin hypersensitivity regimens for superficial incisional infection following cardiac implantable electronic device insertion
Empirical regimens for superficial incisional infection following cardiac implantable electronic device insertion are included below for patients with hypersensitivity to penicillins.
Before starting empirical therapy, obtain blood and wound cultures. For advice on obtaining good quality blood samples for culture, see Principles of obtaining blood for culture.
For patients who have had a hypersensitivity reaction to a penicillin who are at increased risk of MRSA infection, use trimethoprim+sulfamethoxazole or clindamycin.
For adults and children who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin1, use:
1cefalexin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 7 to 10 days. For dosage adjustment in adults with kidney impairment, see cefalexin dosage adjustment cefalexin cefalexin cefalexin
OR (if adherence to a 6-hourly regimen is unlikely in a child)
1cefalexin (child) 20 mg/kg up to 750 mg, orally 8-hourly for 7 to 10 days2. cefalexin cefalexin cefalexin
For adults and children who have had a severe (immediate or delayed)3 hypersensitivity reaction to a penicillin, use trimethoprim+sulfamethoxazole or clindamycin.
Modify therapy based on the results of wound culture and susceptibility testing. If the results of culture are negative, complete 7 to 10 days of therapy using the empirical regimen.