Fresh, brackish, aquarium or soil- or sewage-contaminated water–immersed wounds

For empirical therapy for localised infection of fresh, brackish or aquarium water–immersed wounds not associated with systemic features or involving deeper tissues, use:

1 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 wound infection, water-immersed: localised, fresh, brackish, aquarium trimethoprim + sulfamethoxazole

OR (as a two-drug regimen)

2 ciprofloxacin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 12-hourly¹ ² For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment wound infection, localised: water-immersed (fresh, brackish, aquarium) ciprofloxacin

PLUS EITHER

1 dicloxacillin 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 Wound infection, water-immersed: fresh, brackish, aquarium dicloxacillin

1 flucloxacillin 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. Wound infection, water-immersed: fresh, brackish, aquarium flucloxacillin

For patients at increased risk of MRSA infection (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), use trimethoprim+sulfamethoxazole (see dosage above).

For empirical therapy for localised infection of wounds immersed in soil- or sewage-contaminated water (eg following a flood or natural disaster) not associated with systemic features or involving deeper tissues, add metronidazole to the above regimens:

metronidazole 400 mg (child: 10 mg/kg up to 400 mg) orally, 12-hourly. Wound infection, water-immersed: localised metronidazole

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 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

² 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