T81.4 + (Y83.6/Y83.8-9/B95.6/U82.1)
DESCRIPTION
Common organisms: Gram positive bacteria, especially S. aureus, are the commonest cause. Gram negative and anaerobic bacteria are important causes following gynaecological and intestinal surgery.
Microbiologic specimen: deep wound swab or aspirate of pus, and blood culture.
Suture removal plus incision and drainage is essential. Antibiotics are not usually necessary except if there is marked surrounding cellulitis or features of systemic infection.
MEDICINE TREATMENT
Empiric antibiotic therapy:
Total duration of therapy should not exceed 7 days
If surrounding cellulitis or systemic sepsis not involving the gastro-intestinal (GI) or female genital tract:
- Cefazolin, IV, 1 g 8 hourly.
Follow with oral therapy as soon as patient can swallow and the temperature is <37.8 oC for 24 hours:
- Flucloxacillin, oral, 500 mg 6 hourly.
Check Gram stain of exudate. If Gram negative organism:
ADD
- Piperacillin/tazobactam, IV, 4.5 g 8 hourly.
Severe Penicillin allergy (Z88.0):
- Clindamycin, IV, 600 mg 8 hourly.
Follow with oral therapy as soon as patient can swallow and the temperature is <37.8oC for 24 hours, based on culture results:
- Clindamycin, oral, 450 mg 8 hourly
Check Gram stain of exudate. If Gram negative organism:
ADD
- Ertapenem, IV, 1g daily.
Methicillin (cloxacillin) resistant S. aureus (MRSA)
T81.4 + (B95.6+U82.1+Y83.9)
- Vancomycin, IV, 30 mg/kg as a loading dose. Follow with 20 mg/kg/dose 12 hourly.
- See VANCOMYCIN, IV for guidance on prescribing and monitoring).
- Drain wound and obtain cultures to verify MRSA.
If female uro-genital tract surgery or open GIT surgery:
T81.4 +(Y83.6/Y83.8)
- Ceftriaxone, IV, 2 g daily.
AND
- Metronidazole, IV, 500 mg 8 hourly.