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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