Pamela Orr
Professor, Internal Medicine, Medical
Microbiology and Community Health
Sciences

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Blood cultures if fever history/objective fever/chills/systemic symptoms or signs/immunosuppressed
Check for Tinea pedis if lower extremity involved
Culture any open wounds (including anaerobic culture if deep or necrotic or malodorous)
CBC, urea, creatinine, glucose
Image – eg. CT of orbit and brain
Incise and drain and pack !!

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Cellulitis not associated with wound – usually
Streptococcus A (B/C/G) / MSSA/ MRSA (or Strep
Pneumoniae or Haemophilus influenzae in orbital cellulitis)
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 iv Ceftriaxone 2 gm/day +/- iv Vancomycin
Pen allergy: iv Clindamycin or Vancomycin
Oral: Cloxacillin or Cephalexin (or Clinda if Pen allergic) add Septra or Doxycycline if MRSA is suspected
Cefuroxime-axetil in orbital cellulitis
Eryripelas – Strep A
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 iv Ceftriaxone (or Pen or Ampicillin)
Pen Allergy: iv Clindamycin (or Vanco)
Oral: Penicillin V or Amoxil (or Clinda if Pen allergic)

Diabetic Foot Infection – usually mixed gram +/-
/anaerobes. Decide whether osteomyelitis is present, and assess arterial pulses. Often needs iv therapy. Start with (after cultures):
 eg. iv Ceftriaxone +iv Vanco+ po Metronidazole
 eg. po Amoxicillin/Clavulinic Acid +/- Doxy, or po Septra +
Metro
Wound Infection – likley mixed infection, as above. Same approach. If Water exposure think of Pseudomonas – use
Ceftazidime or Ciprofloxacin instead of Ceftriaxone
Head and Neck Region Infections : Be very cautious