Infectious Diseases  |  Recurrent Skin Sepsis Pathway - 3rd Pass Management Cyclical Systemic Treatment

Third Pass Management:

If Partial Treatment Failure - history or diary indicates some improvement consider repeating last treatment regimen again before preceding to next step.

If Clinical Treatment Failure ( defined as new lesion(s) after full treatment completed) has occurred proceed to:

Swab nose and throat of treatment failures again:

• Simultaneous Cyclical antiseptic daily baths or showers (one week on, 3 weeks off for 3 months) and
  
  

• Cyclical systemic antibiotics, according to sensitivities from previous swabs (one week on, 3 weeks off for 3 months) see information for patients and use diary for index case.
  
  

1. Co-trimoxazole alone first choice (Children 240mg/5mls give 0.5mls/kg/dose bid to maximum of 960mg bid, Adult dose is 960mg bid) or
   
   
2. If allergy or resistance: Rifampicin (10mg/kg/twelve hourly to maximum of 300mg bd which is the adult dose) plus a second Staph-active antibiotic to prevent resistance e.g Doxycycline 100mg bid (over 12 years) or Flucloxacillin (PO 50 mg/kg/day in four divided doses up to a max. 500 mg QID on an empty stomach. Adult dose is 500mg QID).
   
   
   

A simple guide for flucloxacillin dosage is:

• <2 years Flucloxacillin 125mg/5ml 2.5ml qid
• 2-5 years Flucloxacillin 125mg/5ml 5ml qid
• >5 years Flucloxacillin 250 mg/5ml 5ml qid (using 50 mg/kg/day as a cross check).
  
  

Note: both Rifampicin and Flucloxacillin suspension are unpalatable.

Beware drug interactions with rifampicin (especially OCP) and propensity for rifampicin to change colour of urine and secretions etc.

If carried or infecting organism isolated is MRSA, or case has multiple antibiotic allergies, consider early discussion with Infectious Diseases Physician or Clinical Microbiologist - phone via Tauranga Hospital switchboard

NB: Clinicians are welcome to contact (via Hospitals switchboard or Pathlab BOP)infectious disease specialist or microbiologist/pathologist at any stage of this guideline for further advice.