Flucloxacillin should be used rather than Pen V or ampicillin. An alternative to flucloxacillin or macrolides is clindamycin 300 mg qds (though note the risk of colitis).
Differential diagnoses include varicose eczema, erythema nodosum, DVT, acute oedema, and something called lipodermatosclerosis (which is caused by venous insufficiency and usually presents chronically but can come on in an acute form mimicking sclerosis). Points in favour of it being varicose eczema rather than cellulitis include:
- Dry scaly skin
- Systemically well patient
- Signs of venous incompetence
Up to 50% of patients who get a first attack will get another. Risk factors for recurrence include:
- Fungal infection of the lower limb
- Peripheral arterial disease
- Venous insufficiency
Some work has been done on using long-term antibiotic treatment (1 – 2 yrs) to prevent further episodes, but results are not conclusive.
(Pulse on-line learning module)