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Human and animal bite guidelines are available here.

Follow guidelines here for severe skin soft tissue infection in a person who injects drugs.



  • Ensure elevation of affected limb.
  • Demarcate erythema on leg to help assess responses/spread.
  • If qSOFA ≥2 or other evidence of severity including extensive disease use the recommendations below for severe infection and follow Sepsis 6 where required.


Antimicrobial recommendation

Mild infection
Recommended total duration: 5 days
Antibiotic recommendation Flucloxacillin 500mg-1g every 6 hours orally 
Penicillin allergy or previous MRSA

Doxycycline 200mg first dose then 100mg every 24 hours orally


Clarithromycin 500mg every 12 hours orally

Severe infection
Recommended total duration: 7 days (IV and oral)
Antibiotic recommendation Flucloxacillin 2g every 6 hours IV
Penicillin Allergy or previous MRSA Vancomycin IV (use NHS Lothian Calculator on AMT intranet page) choose trough 10-15 mg/L


IV to oral switch

Antimicrobial recommendation Flucloxacillin 1g every 6 hours 

Penicillin Allergy OR Previous MRSA (check any available sensitivities)

Doxycycline 100mg every 12 hours


Clarithromycin 500mg every 12 hours