Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC). See guidance on dosing in children for quick reference dosage/weight guide. Refer to drug interactions table for detailed drug interactions for all antimicrobials. Note extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
Note additional warnings for clarithromycin and fluoroquinolones
Comments from Expert Advisory Committee
- If patient afebrile and otherwise healthy, flucloxacillin may be used as single drug treatment.
- If water exposure, discuss with microbiologist.
- If febrile and ill, admit for IV treatment
- Suspected infection in the foot of a diabetic patient is considered a clinical emergency due to vascular compromise and risk of osteomyelitis . The patient should have a same day urgent referral to secondary care for assessment and treatment
- In facial cellulitis use co-amoxiclav.
- Note: recurrent cellulitis should be managed differently. See Leg Ulcers and recurrent cellulitis
- Aim to identify and modify risk factors for recurrent infections e.g. Diabetes mellitus, poor circulation, tinea infection, immunosuppression.
- Panton-Valentine Leukocidin (PVL) is a toxin produced by 2% of Staphylococcus aureus and is associated with persistent recurrent pustules and carbuncles or cellulitis. Send swabs for culture in these clinical scenarios. On rare occasions it causes more severe invasive infections, even in otherwise fit people. Risk factors include: nursing homes, contact sports, sharing equipment, poor hygiene and eczema.