

Infected Ulcers (e.g. diabetic, vascular, pressure)
- Avoid IV/PO antimicrobials unless clear signs of active infection (use appropriate dressings)
- Often polymicrobial, and superficial swabs can be misleading/of limited value
- Consider underlying osteomyelitis, if probes to bone or underlying bony prominence
- If severe pain or systemically unwell, consider necrotising skin or soft tissue infection (fasciitis) and seek early ID/surgical involvement.
Pathogens
- Common: S. pyogenes, S. aureus, Enterobacteriaceae, anaerobes.
Drug Treatment
- Duration: Minimum of 10 days but longer is often required.
Empiric
Mild to moderate infection
amoxicillin+clavulanic acid
HMLSchedNZFPMLnoids
|
IV 1 g/200 mg every eight hours then PO 500 mg/125 mg three times a day
|
Mild penicillin allergy
- fe = 0.9, consider adjusting dose if CrCl is reduced.
AND
- High oral availability – prescribe orally unless GI absorption is compromised or patient is nil by mouth.
- Metabolised by unknown pathways. (fe = 0.1).
followed by
- fe = 0.9, consider adjusting dose if CrCl is reduced.
AND
- Metabolised by unknown pathways. (fe = 0.1).
Severe penicillin allergy
AND
Severe infection
piperacillin+tazobactam
HMLNZFPMLnoids
|
IV 4 g/500 mg every eight hours
|
- If still on piperacillin+tazobactam beyond 48 hours, consider measuring a trough concentration. Consult Infectious Diseases for interpretation.
- fe (piperacillin) = 0.8, fe (tazobactam) = 0.6, consider adjusting dose if CrCl reduced.
Mild penicillin allergy
- Meropenem rapidly and significantly reduces sodium valproate concentrations. Concomitant administration may precipitate seizures in patients with a pre-existing seizure disorder. Discuss alternative antibiotic options with Infectious Diseases/Clinical Microbiology.
- If still on meropenem beyond 48 hours, consider measuring a trough concentration. Consult Infectious Diseases for interpretation.
- fe = 0.7, start with full dose initially then consider extending dose interval and/or decreasing dose for subsequent doses if CrCl is reduced (< 30 mL/min). Consult pharmacist.
Severe penicillin allergy
Consult Infectious Diseases/Clinical Microbiology
Topic Code: 99261