Empirical therapy for localised post-traumatic wound infection

The following advice applies to patients with localised post-traumatic wound infection not associated with systemic symptoms or involving deeper tissues (such as bones, joints or tendons).

Seek expert advice for penetrating injuries through footwear. While Staphylococcus aureus is the most common pathogen in these infections, empirical treatment regimens should include antibiotics with activity against Gram-negative bacteria (including Pseudomonas aeruginosa).

For empirical therapy for patients at low risk of methicillin-resistant S. aureus (MRSA) infection (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), use:

1dicloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days. For dosage adjustment in adults with kidney impairment, see dicloxacillin dosage adjustment dicloxacillin dicloxacillin dicloxacillin

OR

1flucloxacillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days. 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 5 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 20 mg/kg up to 750 mg orally, 8-hourly for 5 days2. cefalexin cefalexin cefalexin

For patients who have had a severe (immediate or delayed)3 hypersensitivity reaction to a penicillin who are at low risk of MRSA infection, and patients at increased risk of MRSA infection, use:

1trimethoprim+sulfamethoxazole 160+800 mg (child 1 month or older: 4+20 mg/kg up to 160+800 mg) orally, 12-hourly for 5 days. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment trimethoprim + sulfamethoxazole trimethoprim+sulfamethoxazole trimethoprim+sulfamethoxazole

OR

2clindamycin 450 mg (child: 10 mg/kg up to 450 mg) orally, 8-hourly for 5 days4. clindamycin clindamycin clindamycin

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 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