Seawater-immersed wounds

For empirical therapy for localised infection of seawater-immersed wounds (including coral cuts) not associated with systemic features or involving deeper tissues, use:

doxycycline orally, 12-hourly¹ doxycycline doxycycline doxycycline

adult: 100 mg

child less than 21 kg: 2.2 mg/kg²

child 21 to less than 26 kg: 50 mg

child 26 to 35 kg: 75 mg

child more than 35 kg: 100 mg

PLUS EITHER

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 children who cannot take doxycycline, use:

ciprofloxacin 12.5 mg/kg up to 500 mg orally, 12-hourly³ ⁴. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment. ciprofloxacin ciprofloxacin ciprofloxacin

Cefalexin is often preferred to dicloxacillin or flucloxacillin in children because the liquid formulation is better tolerated. It can also be used for patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin⁵, 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-hourly⁶. cefalexin cefalexin cefalexin

For patients at increased risk of MRSA infection (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), trimethoprim+sulfamethoxazole can be used in place of the above regimens. Use:

trimethoprim+sulfamethoxazole 320+1600 mg (child 1 month or over: 8+40 mg/kg up to 320+1600 mg) orally, 12-hourly. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment. trimethoprim + sulfamethoxazole trimethoprim+sulfamethoxazole trimethoprim+sulfamethoxazole

Modify therapy based on the results of culture and susceptibility testing; see Aeromonas species, Vibrio species and Mycobacterium marinum.

If a pathogen is not identified, the duration of therapy is determined by clinical response. A duration of 5 days is likely to be appropriate.

¹ An oral liquid formulation of doxycycline is not marketed in Australia but is available via the Special Access Scheme. For formulation options for children or people with swallowing difficulties, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return

² When used short term (eg less than 21 days), doxycycline has not been associated with tooth discolouration, enamel hypoplasia or bone deposition so can be used in children of all ages.Return

³ Ciprofloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, there are few data from human trials to support this finding. Ciprofloxacin can be used in children when it is the drug of choice.Return

⁴ An oral liquid formulation of ciprofloxacin 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

⁵ 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

⁶ 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