Erysipelas in Adults with Penicillin Allergy or When Flucloxacillin Is Unsuitable
This protocol applies to adults aged 18 years and over who have a penicillin allergy or for whom flucloxacillin is otherwise unsuitable, and whose erysipelas infection is not near the eyes or nose.
Clinical Situation
Where penicillin allergy is documented or flucloxacillin cannot be used, standard first-choice treatment must give way to alternative antibiotic options. This protocol addresses that substitution for uncomplicated erysipelas in adults, including specific considerations for those who are severely unwell or unable to take oral medication.
Treatment Approach
Alternative oral antibiotics are the recommended first-choice route, unless the person is unable to take oral medication or is severely unwell. The specific agent selected depends on individual clinical factors, including pregnancy status.
Full agent selection, course duration, and clinical decision points are available in the complete protocol below.
Clinical Goals
Symptoms are expected to begin improving within 2 to 3 days of starting treatment. Full resolution at 5 to 7 days is not expected — seek further assessment if symptoms worsen rapidly at any time, or do not start to improve within 2 to 3 days.
References
- Table 1 for adults aged 18 years and over
- Alternative first-choice antibiotics for penicillin allergy or if flucloxacillin is unsuitable (give orally unless person unable to take oral or severely unwell)
- If intravenous antibiotics are given, review by 48 hours and consider switching to oral antibiotics if possible.
- Seeking medical help if symptoms worsen rapidly or significantly at any time, or do not start to improve within 2 to 3 days.
- However, skin does take some time to return to normal, and full resolution of symptoms at 5 to 7 days is not expected.
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