Empirical Antibiotic Management based on Texas wound classification [Pennine Acute Trust; 2007]

Gr	Clinical Criteria	culture specimen	OPD option	1st line empirical choice	Penicillin- allergy	Usual duration
1	superf.; eryth./warmth <=2cm beyond ulcer edges, no swelling, no lymphangitis no sys. effects	swab only if pussy, or initial Tx failure	Flu1gQds +Amo500Tds +/-Met400Tds; or: Aug625Tds	Flu1gQds[IV] +Amo500Tds[IV] +/-Met400Tds	Cla500BdIV, or Ery500Qds +/-Met400Tds	1-2w
2	tend./caps., or eryth./warmth >2cm beyond ulcer edges, or lymphangitis, or necrosis, or sys. effects	soft tissue Bx (neuropathic ulcers); swabs (inflamed ulcer margins); BC if sys. effects	Cli300Qds  [!C.diff] +Cip500Bd; or: Aug625Tds	Flu1-2gQdsIV +Amo1gQdsIV +Genta7mg/kgIBW; switch to oral: Flu1gQds +Amo500Tds +Cip500Bd +/-Met400Tds	Cli600QdsIV +Gen7mg/kgIBWOd; switch to oral: Cli300Qds +Cip500Bd	2-4w (IV:>=3-5d)
3	penetrating ulcer; involving bone/joint	BC if sys. effects; Bone Bx if poss; deep soft tissue Bx; [deep soft tissue swabs: of limitied value]	Cli450Qds [!C.diff] +Cip750Bd; or: Aug625Tds	Flu2gIVQds +Amo1gIVTds +Gen7mg/kgOdIBW +/-Met500IVTds; switch to oral: Flu1gQds +Amo1gTds +Cip750Bd +/-Met400Tds	Cli600QdsIV +Gen7mg/kgIBWOd; switch to oral: Cli450Qds +Cip750Bd	6w (IV:>=3-5d)

Flu: QDS: Flucloxacillin: [elderly/intolerant:500mg-]1-2gQDS
Amo: TDS: Amoxicillin: 500tdsPO | 500-1000tdsIV

Aug: TDS: Augmentin: 625tdsPO

Cli: QDS: Clindamycin: 300-450qdsPO | 600qdsIV
Cip: BD: Ciprofloxacin: 500-750bdPO

Met: TDS: Metronidazole: 400tdsPO | 500tdsIV

Cla: BD: Clarithromycin: 500bdIV
Ery: QDS: Erythromycin: 500qdsPO