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*PHYSORDER*
ADULT Skin and Soft Tissue Infections (SSTIs) /
Cellulitis / Abscess
Admission Medication Orders
For HIPAA Compliance reasons, this form
IS NOT TO BE SAVED with patient information.
Selecting the PRINT button will clear all information
Page 1 of 2
Form Origination Date: 11/12
Version: 1
Abscess
Patient Name
MRN
PATIENT IDENTIFICATION LABEL
Version Date: 11/12
ALLERGIES/DRUG SENSITIVITY: 1.
Diagnosis:
from the note.
2.
Cellulitis
3.
Height
cm
4.
Weight:
kg
Diagnostics – Check all that apply – for diabetic foot ulcers see additional physician order forms
CBC with differential
Basic metabolic panel
SSTI bacterial cultures (Exudate/aerobic only): Disinfect the venipucture site with chlorhexidine
gluconate/alcohol using friction in a back and forth motion for 30 seconds. Allow to air dry for 30 seconds.
Abcesss:
Exudate aerobic only (from I&D or open abscess)
Aspiration (from leading edge)
Cellulitis:
Aspiration (from leading edge)
Blood bacterial cultures x 2 (peripheral blood cultures are preferred)
 Choose one of three regimens below
 Adjust doses for renal impairment—see dosing guidelines link for information
 Contact clinical pharmacist or clinical pharmacy specialist covering service, the antimicrobial stewardship
team, or the adult PharmD consult service for assistance if needed
 Make every effort to document organisms in the wound
Regimen I: NON-PURULENT cellulitis (INTACT SKIN)
STANDARD REGIMEN (utilize for penicillin allergy — not anaphylaxis)
Cefazolin _____ gram(s) IV Q 8 H x 5 days (≤80kg use 1g; >80kg use 2g; renally adjust see chart below)
OR
PATIENTS WITH A DOCUMENTED ANAPHYLACTIC CEPHALOSPORIN ALLERGY
Vancomycin (Loading Dose: 25-30 mg/kg) _____mg IV x 1, then (15 mg/kg) _____mg IV Q _____ H x 5 days (for
doses > 2 grams contact PharmD)
Regimen II: PURULENT cellulitis and/or non-drainable abscess (NON-INTACT SKIN)
STANDARD REGIMEN
Vancomycin (Loading Dose: 25-30 mg/kg) _____mg IV x 1, then (15 mg/kg) _____mg IV Q _____ H x 5 days (for
doses > 2 grams contact PharmD)
Physician Signature
SSTIs
Pager ID
Date
Time
OTE 900XXX Rev. 11/12
AM/PM
This form may be completed on line. Tab or move
cursor to text field and type in text.
*PHYSORDER*
For HIPAA Compliance reasons, this form
ADULT Skin and Soft Tissue Infections (SSTIs) /
Cellulitis / Abscess
Admission Medication Orders
Selecting the PRINT button will clear all information
from the note.
Patient Name
MRN
PATIENT IDENTIFICATION LABEL
Page 2 of 2
Form Origination Date: 11/12
Version: 1
IS NOT TO BE SAVED with patient information.
Version Date: 11/12
Management Considerations
Refer to Adult Skin and Soft Tissue Infection algorithm for clinical criteria for antibiotic treatment de-escalation and oral
antibiotic recommendations. Link
Refer to guidelines for prevention, diagnosis and treatment of SSTIs for insights into dosing and antimicrobial
selection. Link
Clinical Pharmacy Specialists, the Antimicrobial Stewardship Team, or the Adult PharmD Consult Service are available
for assistance with drug dosing for patients with impaired renal and hepatic function.
Antibiotic dosing based on renal function (see also http://kdpnet.louisville.edu/renalbook/adult/):
> 50
≥ 30 to ≤ 50
≥ 10 to ≤ 30
≤ 10 or HD
CVVH
1 grams IV Q8H
1 grams IV Q8H
1 grams IV Q12H
1 gram IV Q24H (after HD)
1 grams IV Q12H
15 mg/kg IV Q8-12H
15 mg/kg IV Q12-24H
15 mg/kg IV
Q24-48H
≤ 10: dose based on levels
HD: 15 mg/kg after each HD
15 mg/kg Q24H
CrCl (mL/min)
Cefazolin
Vancomycin+
+
Adjust dosing based on trough levels (goal 10-20 mcg/mL)
Physician Signature
SSTIs
Pager ID
Date
Time
OTE 900XXX Rev. 11/12
AM/PM