Leg Ulcers soft tissue infection - Management of Infection Guidance for Primary Care

Publication: 30/09/2010  --
Last review: 01/01/1900  
Next review: 01/04/2018  
Clinical Guideline
ID: 2257 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2010  


This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Leg ulcers soft tissue infection



Preferred option


Leg ulcers soft tissue infection

Bacteria will always be present.
Antibiotics do not improve ulcer healing 1A+  
Treat only if active infection:

  • cellulitis
  • increased pain
  • pyrexia
  • purulent exudates
  • odour2C

Send pre-treatment swab if active infection3C
Review antibiotics after culture results.

If diabetic patient see also LHP Clinical guidelines for the management of adult diabetic foot infections

Flucloxacillin electronic Medicines Compendium information on Flucloxacillin
500 mg QDS
7 days.

If history of MRSA colonisation or MRSA grown from wound swab:
Doxycycline electronic Medicines Compendium information on Doxycycline
200mg stat/100mg OD
7 days

If slow response continue for 10-14 days total

Over 65 years:
Clarithromycin electronic Medicines Compendium information on Clarithromycin
500mg BD
Under 65 years:
Clindamycin electronic Medicines Compendium information on Clindamycin
300–450 mg QDS

If slow response continue for 10-14 days total


Record: 2257
  • to provide a simple, empirical approach to the treatment of common infections
  • to promote the safe, effective and economic use of antibiotics
  • to minimise the emergence of bacterial resistance and reduce the incidence of Healthcare Associated Infections in the community
Clinical condition:

Leg Ulcers soft tissue infection

Target patient group:
Target professional group(s): Primary Care Doctors
Adapted from:

This guidance was initially developed in 1999 by practitioners in South Devon, as part of the S&W Devon Joint Formulary Initiative, and Cheltenham & Tewkesbury Prescribing Group and modified by the PHLS South West Antibiotic Guidelines Project Team, PHLS Primary Care Co-ordinators and members of the Clinical Prescribing Sub-group of the Standing Medical Advisory Committee on Antibiotic Resistance. It was further modified following comments from Internet users. The guidance has been updated annually as significant research papers, systematic reviews and guidance have been published. The Health Protection Agency works closely with the authors of the Clinical Knowledge Summaries.

Evidence base

Grading of guidance recommendations

The strength of each recommendation is qualified by a letter in parenthesis.

Study design


Good recent systematic review of studies


One or more rigorous studies, not combined


One or more prospective studies


One or more retrospective studies


Formal combination of expert opinion


Informal opinion, other information


Clinical Knowledge Summaries web http://www.prodigy.nhs.uk. BNF (No 55), SMAC report - The path of least resistance (1998), SDHCT Medical Directorate guidelines + GU medicine guidelines, Plymouth Management of Infection Guidelines project LRTI and URTI.

Leg ulcer

  1. O’Meara S, Al-Khurdi D, Ovington LG. Antibiotics and antiseptics for venous leg ulcers. Cochrane Database of Systematic Reviews. 2010. Issue 1. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003557/frame.html (Accessed 27th January 2010). Most studies identified by this Cochrane review were of poor methodological quality. Use of antibiotics did not promote healing compared to placebo in four trials of people with leg ulcers without visible signs of infection.
  2. RCN The nursing management of patients with venous leg ulcers. Recommendations. Royal College of Nursing. 2006 www.rcn.org.uk Expert consensus is that swabbing (and so by definition antibiotic therapy) is unnecessary unless there is evidence of clinical infection such as inflammation, redness, or cellulitis; increased pain; purulent exudates; rapid deterioration of the ulcer; pyrexia; or foul odour.
  3. Health Protection Agency. Investigation of skin and superficial wound swabs. National Standard Method BSOP 11 Issue 3. http://www.hpa-standardmethods.org.uk/pdf_sops.asp. (Accessed 27th January 2010). Wound swabs should be taken from clinically infected ulcers before starting antibiotics. Taking swabs after starting antibiotics may affect the swab results. Sensitivity results can help guide the appropriate use of further antibiotics if the infection is not clinically improving on empirical treatment.

Document history

LHP version 1.0

Related information

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