›Remove sutures partially if purulence under closure
›Open and drain if abscess suspected
›Packing if cavity present
›Elevation for edema reduction
›Non adherent dressing
›Avoid occlusive dressing if draining
Antibiotics and tetanus
›Anti infective and prophylaxis
›Cephalexin PO 500 mg every 6 hours for 5 days for mild non purulent cellulitis local protocol dependent
›Clindamycin PO 300 mg every 6 hours for 5 days for beta lactam allergy local protocol dependent
›Doxycycline PO 100 mg twice daily for 5 days for MRSA risk with purulence local protocol dependent
›Add amoxicillin clavulanate PO 875 mg twice daily for bite wounds local protocol dependent
›Tetanus booster if not up to date local protocol dependent
Pain control
›Analgesia
›Acetaminophen PO 1000 mg every 6 to 8 hours maximum 3000 mg per day local protocol dependent
›Ibuprofen PO 400 mg every 6 to 8 hours with food if no contraindication
›Avoid NSAIDs if significant bleeding or renal risk
Reassessment loop
›Recheck plan
›Repeat vitals after analgesia and fluids if given
›Reassess wound after irrigation and drainage
›Reassess distal neurovascular status after any procedure
›Reassess pain trajectory within 30 to 60 minutes in ED
Consultation
›Specialty triggers
›Hand surgery for hand infections or tendon involvement
›Orthopedics for joint involvement or hardware
›Vascular surgery for ischemia or expanding hematoma
›General surgery for necrotizing infection concern
17Disposition/dispo18
Discharge criteria
›Safe discharge
›Hemodynamically stable
›No systemic toxicity
›No necrotizing infection concern
›No deep structure exposure
›Reliable wound care and follow up
Observation or admission criteria
›Higher level care
›Systemic infection signs
›Rapid progression despite initial care
›Extensive cellulitis
›Need for IV antibiotics
›Uncontrolled pain
›High risk host factors with infection
Transfer criteria
›Transfer triggers
›Suspected necrotizing infection
›Compartment syndrome concern
›Complex hand infection
›Threatened limb perfusion
18Discharge Instructions/di10
Copy discharge instructions
›Patient instructions
›Keep the wound clean and dry for the next 24 hours unless told otherwise
›Change the dressing daily or sooner if wet or dirty
›Do not soak the wound in a bath or pool until fully healed
›Elevate the area when possible to reduce swelling
›Take your antibiotics exactly as prescribed if given
›Use acetaminophen or ibuprofen as directed for pain unless you were told not to
›Return immediately for fever, spreading redness, worsening pain, pus, bad smell, wound opening, numbness, weakness, pale or cold skin, or uncontrolled bleeding
›Follow up in 24 to 48 hours for recheck if infection concern or drainage was performed
›Suture removal timing depends on location and will be arranged or discussed in follow up
19References/r6
Guidelines and key sources
›Reference list
›Infectious Diseases Society of America practice guidelines for skin and soft tissue infections 2014
›ACEP clinical policy and resources for skin and soft tissue infections and abscess care local protocol dependent
›CDC tetanus vaccination recommendations 2024
›NICE guidance on surgical site infection prevention and management latest update local protocol dependent
›UpToDate wound management and laceration repair aftercare topic review local protocol dependent
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.