Remote Primary Health Care Manuals

Water-related skin infections

Existing cuts, abrasions, wounds and any skin injuries occurring in water often get infected, eg injuries from coral or fish spines

Red Flags — Urgent Medical Consult
  • Skin infections that are not improving after 24 hours of antibiotics
  • People with
    • Weakened immune system
    • Liver failure
    • Kidney failure, diabetes
    • Hazardous alcohol use
    • Severe infection

Do not

  • Do not close puncture wounds

Check 

  • Calculate age-appropriate REWS
    • Adult — AVPU, RR, O2 sats, pulse, BP, Temp
    • Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
  • Weight, BGL
  • Immunisation status — tetanus

Do

  • Thoroughly clean wound and remove embedded material if present
    • May need local anaesthetic
  • Collect swab for MC&S.  Specify ‘marine infection’
  • Treat — Table 7.26

Table 7.26 Treatment for water-related skin infections

Infection

Treatment

 MILD

Appearing as cellulitis or boil

Treat as for cellulitis

MODERATE

Fresh or brackish water

Give trimethoprim-sulfamethoxazole oral — adult 320+1600mg, child 8+40mg/kg/dose up to 320+1600mg — doses — twice a day (bd)

Fresh or brackish water
– if soil or sewage
contaminated

ADD metronidazole oral — adult 400mg, child 10mg/kg/dose up to 400mg — doses — twice a day (bd)

Salt water
If MRSA risk is LOW

 

Medical consult to give ciprofloxacin oral — adult 500mg, child 12.5mg/kg/dose up to 500mg — doses — twice a day (bd) 

AND give ceftriaxone IV/IM — adult 2g, child 50mg/kg/dose up to 2g — doses — single dose

Salt water
If MRSA risk is HIGH

 

Medical consult to give ciprofloxacin oral — adult 500mg, child 12.5mg/kg/dose up to 500mg — doses — twice a day (bd) 

AND trimethoprim-sulfamethoxazole oral — adult 320+1600mg, child 8+40mg/kg/dose up to 320+1600mg — doses — twice a day (bd)

SEVERE

Severe or unresolved
water-related infections

Medical/specialist consult

  • Severe infection may need treatment in hospital — can become necrotising fasciitis
  • Unresolving ulcer might be mycobacterium marinum

Follow-up — review after 24 hours

Moderate infection — fresh or brackish water

  • If not improving or getting worse — medical consult to send hospital
  • If getting better — continue antibiotics for 5 days
  • Review again with swab result

Moderate infection — salt water

  • If getting worse or not getting better — medical/specialist consult to send to hospital
  • If getting better and MRSA risk is low
    • Change ceftriaxone dose to cefalexin oral — doses — adult 500mg, child 12.5mg/kg/dose up to 500mg, 4 times a day (qid)
    • Continue antibiotics for 5 days
    • If allergy — medical consult
  • If getting better and MRSA risk is high — continue antibiotics for 5 days
  • Review again with swab result