Soft Tissue Injury, established Infection
For skin and soft tissue wounds that have developed secondary infection
- Thorough cleaning and/or surgical debridement may be indicated
- Tetanus risk assessment should be performed. See also Tetanus-prone wounds
- Take a swab if discharge from wound and send to microbiology. Re-assess wound after 24-48 hours if no improvement.
- Treat for 5-7 days depending on response to therapy.
Preferred
co-amoxiclav 30mg/kg (Max 1.2g) iv TDS (BD if 1-2 months old)
Oral switch: co-amoxiclav po (see dosing table)
| Age | co-amoxiclav oral dose |
| 1 month to 11 months |
0.5mL/kg of 125mg/31mg/5mL suspension TDS |
| 1 year to 5 years |
10mLs of 125mg/31mg/5mL suspension TDS |
| 6 years to 17 years |
One 625mg tablet TDS OR 10mLs of 250mg/62mg/5mL suspension TDS if patient cannot take tablets |
Alternative
For penicillin allergy (non-severe and severe) or MRSA sensitive to clindamycin
For patients one month and over:
clindamycin 10mg/kg (max 600mg) iv QDS
Oral switch: clindamycin 6mg/kg (max 450mg) po QDS
For other MRSA positive patients: vancomycin iv
Oral switch: co-trimoxazole po (see dosing table)
| Age | co-trimoxazole oral dose |
| 6 Weeks to 5 Months | 120mg BD |
| 6 Months to 5 Years | 240mg BD |
| 6 Years to 11 years | 480mg BD |
| 12 years to 17 years | 960mg BD |
For infected wounds with exposure to fresh- or sea- water:
For patients one month and over: ADD ciprofloxacin* 20mg/kg (max 750mg) po BD
* Note: Ciprofloxacin may induce convulsions in patients with or without a history of convulsions – use with caution
Also Note: If patient is prescribed ciprofloxacin ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet.
For more information about MHRA safety alerts and patient or carer counselling See Fluoroquinolone antibiotics - paediatric position statement