Patients at low risk of polymicrobial and MRSA infection

For mild infection of diabetes-related foot ulcers in patients at low risk of polymicrobial infection (see Antibiotic choice for mild infection of diabetes-related foot ulcers) and low risk of methicillin-resistant Staphylococcus aureus (MRSA) infection (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), use:

1dicloxacillin 500 mg orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see dicloxacillin dosage adjustment. See advice on duration of therapy dicloxacillin dicloxacillin dicloxacillin

OR

1flucloxacillin 500 mg orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see flucloxacillin oral dosage adjustment. See advice on duration of therapy. flucloxacillin flucloxacillin flucloxacillin

For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin1, use:

cefalexin 500 mg orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see cefalexin dosage adjustment. See advice on duration of therapy. cefalexin cefalexin cefalexin

For patients who have had a severe (immediate or delayed)2 hypersensitivity reaction to a penicillin, use one of the regimens for patients at low risk of polymicrobial infection and increased risk of MRSA infection.

Modify therapy based on the results of culture and susceptibility testing.

1 Cefalexin may be used in patients who have had a nonsevere (immediate or delayed) reaction to amoxicillin or ampicillin. However, because cross-reactivity between these drugs is possible, consideration should be given to the extent of the reaction, patient acceptability, and the suitability of non–beta-lactam options.Return
2 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse. Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return