Wounds not requiring surgical management

For patients with significantly contaminated wounds that do not require surgical management, oral antibiotic therapy can be used in combination with careful cleaning and debridement. Use:

1dicloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see dicloxacillin dosage adjustment dicloxacillin dicloxacillin dicloxacillin

1flucloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see flucloxacillin oral dosage adjustment. flucloxacillin flucloxacillin flucloxacillin

For patients 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 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 20 mg/kg up to 750 mg orally, 8-hourly². cefalexin cefalexin cefalexin

For patients who have had a severe (immediate or delayed)³ hypersensitivity reaction to a penicillin, use:

clindamycin 450 mg (child: 10 mg/kg up to 450 mg) orally, 8-hourly⁴. clindamycin clindamycin clindamycin

Duration of therapy: for deep, penetrating injuries that cannot be adequately debrided (eg penetrating nail injuries), give prophylaxis for 72 hours. For all other wounds, give prophylaxis for 24 hours.

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² Unpublished pharmacokinetic and pharmacodynamic modelling data for cefalexin show similar levels of target attainment with the 6- and 8-hourly regimens above. It is the consensus view of the Antibiotic Expert Group that either regimen can be used for children.Return

³ 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

⁴ An oral liquid formulation of clindamycin is not commercially available; for formulation options for children or people with swallowing difficulties, see the Don’t Rush to Crush Handbook, published by the Society of Hospital Pharmacists of Australia [URL].Return