Abdominal Wound Infection (Post-operative)

• Mild erythema may not require antimicrobial therapy.

Slowly spreading cellulitis

amoxicillin+clavulanic acid HMLSchedNZFPMLnoids Amoxicillin+Clavulanic Acid F: 0.9 / 0.5 Half life: 2 hours / 1 hour Elimination: renal fe: 0.9 / 0.5

IV 1 g/200 mg every eight hours

• fe (amoxicillin) = 0.9, fe (clavulanic acid) = 0.5, consider adjusting dose if CrCl reduced.

OR

cefuroxime HMLSchedNZFPMLnoids Cefuroxime F: 0.4 Half life: 2 hours Elimination: renal fe: 0.9

IV 1.5 g every eight hours

• fe = 0.9, consider adjusting dose if CrCl reduced.

PLUS or MINUS

metronidazole HMLSchedNZFPMLnoids Metronidazole F: 1 Half life: 8 hours Elimination: oxidation, glucuronidation fe: 0.1

PO 600 mg twice a day.

• High oral availability – prescribe orally unless GI absorption is compromised or patient is nil by mouth.
• Metabolised by unknown pathways. (fe = 0.1).

Modify according to Gram stain or swab results.

Rapidly spreading cellulitis with systemic toxicity

May indicate severe infection including fasciitis. Consult urgently with Infectious Diseases/Clinical Microbiology.

• High oral availability – prescribe orally unless GI absorption is compromised or patient is nil by mouth.
• Metabolised by unknown pathways. (fe = 0.1).

AND

gentamicin HMLSchedNZFPMLnoids Gentamicin F: n/a Half life: 3 hours Elimination: renal fe: 0.9 Additional points: TDM.

See dosing guidelines

• fe = 0.9, adjust dose if CrCl reduced.

AND

flucloxacillin HMLSchedNZFPMLnoids Flucloxacillin F: 0.9 Half life: 1 hour Elimination: renal fe: 0.7

IV 2 g every six hours

• fe = 0.7, consider adjusting dose if CrCl reduced.
• Risk of hepatotoxicity is increased in females, patients > 55 years old, high doses, and courses longer than 14 days duration.

Surgical debridement should be considered.

Topic Code: 99288

must be prescribed or recommended by a consultant.