Gram-negative or anaerobic bacteria
For superficial surgical site infection, if Gram-negative or anaerobic bacteria are suspected (eg the procedure entered the gastrointestinal, respiratory or genitourinary tracts), use:
amoxicillin+clavulanate 875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally, 12-hourly1. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate oral dosage adjustment. See below for duration of therapy. amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate
For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin2, as a 2-drug regimen, 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. See below for duration of therapy 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-hourly3. See below for duration of therapy cefalexin cefalexin cefalexin
PLUS with either of the above regimens
metronidazole 400 mg (child: 10 mg/kg up to 400 mg) orally, 12-hourly. See below for duration of therapy. metronidazole metronidazole metronidazole
For patients who have had a severe (immediate or delayed)4 hypersensitivity reaction to a penicillin, use:
trimethoprim+sulfamethoxazole 160+800 mg (child 1 month or older: 4+20 mg/kg up to 160+800 mg) orally, 12-hourly. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment. See below for duration of therapy trimethoprim + sulfamethoxazole trimethoprim+sulfamethoxazole trimethoprim+sulfamethoxazole
PLUS
metronidazole 400 mg (child: 10 mg/kg up to 400 mg) orally, 12-hourly. See below for duration of therapy. metronidazole metronidazole metronidazole
Modify therapy based on the results of culture and susceptibility testing.
Duration of therapy: continue antibiotic therapy for 5 days; a longer duration may be required depending on clinical response. If there is a poor response to empirical therapy, review whether the pathogen is adequately treated and re-evaluate the wound for evidence of deeper tissue involvement.