treatment of infection

Last reviewed 01/2018

  • all venous leg ulcers become colonized by a range of bacteria but usually there are no clinical consequences
  • routine swabbing of the ulcer and treatment with antibiotics is not recommended
  • if an infected venous ulcer is suspected, a swab should be taken before prescribing an antibiotic (1). Antibiotics should be given systemically when there are symptoms and signs of cellulitis:
      • pain
      • pyrexia
      • erythema around the ulcer
      • lymphangitis
      • increasing size of ulcer
    • other signs of infected leg ulcer include increased exudate and foul odour (1).
  • while awaiting swab results, prescribe flucloxacillin 500mg capsules (adult dose), one capsule four times a day for 7 days (or erythromycin or clarithromycin if the person is allergic to penicillin)(1)
  • the patient should be reviewed within 3 days to ensure treatment response of the ulcer. Ideally, a person with infected venous leg ulcers should be followed up daily or every 2 to 3 days until a clinical improvement is seen
  • inspect and compare the ulcer and surrounding skin for signs of improvement:
    • reduced inflammation
    • development of healthy pink granulation tissue
    • reducing exudate
  • also check for improvement in pain, oedema, and pyrexia (1)
  • if the infection does not improve, check swab results and consider changing the antibiotic based on sensitivity information. Also, consider possible complications or allergic contact dermatitis as a cause for the ongoing symptoms (1)
  • if the infection is sensitive to the empirical antibiotic but only slowly responding and not deteriorating, review after 7 days and consider continuing the antibiotic for a further 7 days (1)
  • if there are signs of worsening infection (spreading redness, increasing pain, and systemic upset) consider osteomyelitis or septicaemia, and admit the person to hospital for intravenous antibiotics (1)
  • after the infection has settled, follow up the person as for an uncomplicated venous ulcer (1)
  • appropriate antibiotic therapy should be determined by the bacteriological sensitivity or the organism
  • topical antibiotics are not recommended (1)
  • a potassium permanganate 0.01% soak can be considered for foul odour (1)

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