Dawaa Reference

infectious

Infected wound or laceration

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

Cellulitis and erysipelas - disease-level clinical article (cellulitis-clinical.txt) · Post-Exposure Tetanus Prophylaxis - disease-level clinical article (tetanus-prophylaxis-clinical.txt) · IDSA Practice Guidelines for Skin and Soft Tissue Infections 2014 · Egyptian National Drug Formulary - Antimicrobial 2023 (cefadroxil monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph)

Verified against6 documents
  • Cellulitis and erysipelas - disease-level clinical article (cellulitis-clinical.txt)
  • Egyptian National Drug Formulary - Antimicrobial 2023
  • Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph)
  • Egyptian National Drug Formulary - Antimicrobial 2023 (cefadroxil monograph)
  • IDSA Practice Guidelines for Skin and Soft Tissue Infections 2014
  • Post-Exposure Tetanus Prophylaxis - disease-level clinical article (tetanus-prophylaxis-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Redness spreading outward from the wound edges over the days after the injury, rather than settling [redness]
  • Pain that goes on increasing after the first 48 hours, when a clean wound should be hurting less each day
  • Wound discharge that turns thick, cloudy or foul, instead of the thin clear fluid of early healing [wound discharge]
  • Fever or chills alongside the wound mean the infection is no longer confined to the skin [chills · fever]
  • How the wound happened decides the tetanus risk: a puncture, a crush, a burn, an avulsion, or an animal or human bite is a high-risk wound [animal bite]

Signs — what you find (6)

  • Pus coming from the wound, or a fluctuant swelling beside it, points to an abscess that needs drainage and not antibiotics alone [abscess · pus]
  • Local tenderness and warmth over redness that extends past the wound margin is cellulitis of the surrounding skin [cellulitis · local tenderness · redness]
  • Tender lymphadenopathy in the draining group - the groin for a leg wound, the axilla for an arm wound [lymphadenopathy]
  • Look into the wound for a retained foreign body and check the blood supply; a missed foreign body is a predisposing factor for tetanus [foreign body]
  • Red flag: pain out of proportion to the wound, with crepitus or dusky skin, suggests necrotising fasciitis - a surgical emergency needing immediate debridement [crepitus]
  • Red flag: fever above 38C, pulse over 90, or respiratory rate over 20 are systemic signs, and two or more of them means admission rather than an oral course [fever · tachycardia]

Tests (3)

  • The diagnosis is clinical. No test is needed for a straightforward infected wound
  • Take blood cultures where there are signs of systemic toxicity, where the infection persists despite adequate treatment, or after an animal bite or a water-associated injury
  • Ask for the tetanus immunisation history in doses, not in impressions: fewer than three, or unknown, is treated as unimmunised

If not this — what else fits (5)

  • Cellulitis with no wound at all - same skin findings, no breach to explain them
  • Necrotising fasciitis - the emergency this card exists to make you consider
  • A retained foreign body keeping the wound from healing, which no antibiotic will fix
  • An animal or human bite, which changes both the antibiotic and the rabies question
  • Normal healing inflammation in the first 48 hours, which is redness that recedes rather than advances

SourceCellulitis and erysipelas + Post-Exposure Tetanus Prophylaxis - disease-level clinical articles

Presentation findings are traced to the source above.

Rx: Main treatment | Antibiotic - non-purulent wound | Antibiotic - bite wound | Add for a purulent wound or MRSA risk | If severely beta-lactam allergic

MAIN TREATMENT

1

WOUND TOILET, TETANUS ASSESSMENT & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Paediatric dose

Same for children; the tetanus decision uses the same wound classification.

Dose source

Post-Exposure Tetanus Prophylaxis - disease-level clinical article (tetanus-prophylaxis-clinical.txt)

Why

The non-drug backbone. Cleaning and debridement carry the tetanus source's own instruction that prophylaxis is given in conjunction with them, not instead of them.

Cautions
  • Classify the wound before deciding tetanus cover. The source's split is low risk (clean and minor) versus high risk (contaminated, puncture, avulsions, or resulting from missiles, crushing, burns, animal or human bites, or frostbite).
  • Fewer than 3 prior doses or unknown: give the vaccine for a low-risk wound; for a high-risk wound give both the vaccine and human tetanus immune globulin.
  • Three or more prior doses: vaccine only if the last dose was over 10 years ago for a low-risk wound, or over 5 years ago for a high-risk wound.
  • Give prophylaxis as soon as possible, and still give it on delayed presentation - the incubation period is long and variable.
  • Look for a retained foreign body and for compromised blood supply. A missed foreign body is listed as a predisposing factor for tetanus.
  • Tetanus-prone wounds may be left open, to avoid the anaerobic conditions the organism needs.

ANTIBIOTIC - NON-PURULENT WOUND - choose one

2

CEFALEXIN

Antibiotic - non-purulent wound

1st line

Formoral.solid

Adult dose and duration

500 mg every 6 hours, or 1 g twice daily x 5-7 days

Paediatric dose

25-50 mg/kg/day [child max 2000 mg]

Dose by weight
3kg75-150 mg/day
4kg100-200 mg/day
5kg125-250 mg/day
6kg150-300 mg/day
7kg175-350 mg/day
8kg200-400 mg/day
9kg225-450 mg/day
10kg250-500 mg/day
11kg275-550 mg/day
12kg300-600 mg/day
13kg325-650 mg/day
14kg350-700 mg/day
15kg375-750 mg/day
16kg400-800 mg/day
17kg425-850 mg/day
18kg450-900 mg/day
19kg475-950 mg/day
20kg500-1000 mg/day
21kg525-1050 mg/day
22kg550-1100 mg/day
23kg575-1150 mg/day
24kg600-1200 mg/day
25kg625-1250 mg/day
26kg650-1300 mg/day
27kg675-1350 mg/day
28kg700-1400 mg/day
29kg725-1450 mg/day
30kg750-1500 mg/day
31kg775-1550 mg/day
32kg800-1600 mg/day
33kg825-1650 mg/day
34kg850-1700 mg/day
35kg875-1750 mg/day
36kg900-1800 mg/day
37kg925-1850 mg/day
38kg950-1900 mg/day
39kg975-1950 mg/day
40kg1000-2000 mg/day
41kg1025-2000 mg/day (upper capped)
42kg1050-2000 mg/day (upper capped)
43kg1075-2000 mg/day (upper capped)
44kg1100-2000 mg/day (upper capped)
45kg1125-2000 mg/day (upper capped)
46kg1150-2000 mg/day (upper capped)
47kg1175-2000 mg/day (upper capped)
48kg1200-2000 mg/day (upper capped)
49kg1225-2000 mg/day (upper capped)
50kg1250-2000 mg/day (upper capped)
Choice

The guideline-named agent for non-purulent infection. Cefadroxil is the twice-daily alternative where cefalexin is not stocked.

Dose source

IDSA Practice Guidelines for Skin and Soft Tissue Infections 2014

Why

First choice when the infection is non-purulent spreading redness around the wound. The dose is the one already carried by the cellulitis card, whose source states cephalexin 500 mg every 6 hours for non-purulent cellulitis with a course of at least 5 days.

Cautions
  • Covers streptococci and MSSA. It does not cover MRSA - see co-trimoxazole if the wound is purulent or there are MRSA risk factors.
Egyptian brands
Egyptian brandManufacturerIndicative price
AMTHROST 250 MG 10 F.C. TAB.SIGMA > SABAA4.00 EGP (0.40/unit)
CEPHALEXIN 250MG 12CAPS. B.P.2000ARAB DRUG COMPANY (ADCO)5.28 EGP (0.44/unit)
CEPHALEXCID 250MG 12CAPS.CID6.43 EGP (0.54/unit)
STARCEF 500MG 20 CAP.SIGMA18.00 EGP (0.90/unit)
STARCEF 1GM 12 F.C. TAB.SIGMA20.40 EGP (1.70/unit)
OSPEXIN 1000 MG 12 TABS.EL NILE. > NOVARTIS28.80 EGP (2.40/unit)
CEPOREX 1 GM 8 TABLETSGLAXO SMITHKLINE78.00 EGP (9.75/unit)
CEPOREX 250 MG/5ML SYRUP 60 MLGLAXO SMITHKLINE23.50 EGP
AMTHROST 125MG/5ML SUSP. 60ML? strength differs? different route - not oral solidSIGMA > SABAA4.00 EGP
AMTHROST 250MG/5ML SUSP. 60ML? strength differs? different route - not oral solidSIGMA > SABAA4.50 EGP
3

CEFADROXIL

Antibiotic - non-purulent wound

1st line

Formoral.solid

Adult dose and duration

500 mg to 1 g twice daily (every 12 hours) x 5-7 days

Paediatric dose

30-50 mg/kg/day [child max 2000 mg]

Dose by weight
3kg90-150 mg/day
4kg120-200 mg/day
5kg150-250 mg/day
6kg180-300 mg/day
7kg210-350 mg/day
8kg240-400 mg/day
9kg270-450 mg/day
10kg300-500 mg/day
11kg330-550 mg/day
12kg360-600 mg/day
13kg390-650 mg/day
14kg420-700 mg/day
15kg450-750 mg/day
16kg480-800 mg/day
17kg510-850 mg/day
18kg540-900 mg/day
19kg570-950 mg/day
20kg600-1000 mg/day
21kg630-1050 mg/day
22kg660-1100 mg/day
23kg690-1150 mg/day
24kg720-1200 mg/day
25kg750-1250 mg/day
26kg780-1300 mg/day
27kg810-1350 mg/day
28kg840-1400 mg/day
29kg870-1450 mg/day
30kg900-1500 mg/day
31kg930-1550 mg/day
32kg960-1600 mg/day
33kg990-1650 mg/day
34kg1020-1700 mg/day
35kg1050-1750 mg/day
36kg1080-1800 mg/day
37kg1110-1850 mg/day
38kg1140-1900 mg/day
39kg1170-1950 mg/day
40kg1200-2000 mg/day
41kg1230-2000 mg/day (upper capped)
42kg1260-2000 mg/day (upper capped)
43kg1290-2000 mg/day (upper capped)
44kg1320-2000 mg/day (upper capped)
45kg1350-2000 mg/day (upper capped)
46kg1380-2000 mg/day (upper capped)
47kg1410-2000 mg/day (upper capped)
48kg1440-2000 mg/day (upper capped)
49kg1470-2000 mg/day (upper capped)
50kg1500-2000 mg/day (upper capped)
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (cefadroxil monograph)

Why

The same first-line cephalosporin step in the form most reliably stocked in Egypt - 41 products in the national register against 43 for cefalexin. Twice-daily dosing also aids adherence.

Cautions
  • Same cephalosporin class and the same gap as cefalexin: no MRSA cover. Switch or add co-trimoxazole if the wound is purulent.
  • Cross-reactivity means it is not the answer for a patient with a severe penicillin or cephalosporin allergy - use clindamycin.
Egyptian brands
Egyptian brandManufacturerIndicative price
MEGADROXIL 500 MG 8 CAPS.SHIFA MEDICAL PRODUCTS > MASH PREMIERE4.50 EGP (0.56/unit)
CEFADROXIL 500MG 8 CAPS.SIGMA7.50 EGP (0.94/unit)
DURICEF 250MG 8 CAPS.SMITHKLINE BEECHAM7.90 EGP (0.99/unit)
BIODROXIL 500MG 8 CAPS.KAHIRA > NOVARTIS10.50 EGP (1.31/unit)
CEFEX 1 GM 8 F.C.TABS.SIGMA TEC > FUTURE PHARMACEUTICAL INDUSTRIES (FPI)22.50 EGP (2.81/unit)
CURISAFE 1 GM 8 F.C. TABS.PHARCO B76.00 EGP (9.50/unit)
CEFADROXIL 1 GM 6 DISPERSIBLE TAB.SIGMA12.00 EGP
DURICEF 1 GM 6 DISPERSABLE TAB.SMITHKLINE BEECHAM58.00 EGP
LONGICEF 125MG/5ML SUSP. 60 ML? strength differs? different route - not oral solidKAHIRA4.25 EGP
CEFADROXIL 250MG/5ML PD. FOR ORAL SUSP. 60ML? strength differs? different route - not oral solidSIGMA7.50 EGP

ANTIBIOTIC - BITE WOUND

4

AMOXICILLIN + CLAVULANIC ACID

Antibiotic - bite wound

1st line

Formoral.solid

Adult dose and duration

875/125 mg twice daily x 5-7 days

Paediatric dose

25-45 mg/kg/day [child max 1750 mg]

Dose by weight
3kg75-135 mg/day
4kg100-180 mg/day
5kg125-225 mg/day
6kg150-270 mg/day
7kg175-315 mg/day
8kg200-360 mg/day
9kg225-405 mg/day
10kg250-450 mg/day
11kg275-495 mg/day
12kg300-540 mg/day
13kg325-585 mg/day
14kg350-630 mg/day
15kg375-675 mg/day
16kg400-720 mg/day
17kg425-765 mg/day
18kg450-810 mg/day
19kg475-855 mg/day
20kg500-900 mg/day
21kg525-945 mg/day
22kg550-990 mg/day
23kg575-1035 mg/day
24kg600-1080 mg/day
25kg625-1125 mg/day
26kg650-1170 mg/day
27kg675-1215 mg/day
28kg700-1260 mg/day
29kg725-1305 mg/day
30kg750-1350 mg/day
31kg775-1395 mg/day
32kg800-1440 mg/day
33kg825-1485 mg/day
34kg850-1530 mg/day
35kg875-1575 mg/day
36kg900-1620 mg/day
37kg925-1665 mg/day
38kg950-1710 mg/day
39kg975-1750 mg/day (upper capped)
40kg1000-1750 mg/day (upper capped)
41kg1025-1750 mg/day (upper capped)
42kg1050-1750 mg/day (upper capped)
43kg1075-1750 mg/day (upper capped)
44kg1100-1750 mg/day (upper capped)
45kg1125-1750 mg/day (upper capped)
46kg1150-1750 mg/day (upper capped)
47kg1175-1750 mg/day (upper capped)
48kg1200-1750 mg/day (upper capped)
49kg1225-1750 mg/day (upper capped)
50kg1250-1750 mg/day (upper capped)
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph)

Why

For a wound caused by an animal or human bite. The cellulitis source names Pasteurella multocida after a dog or cat bite, which the cephalosporins above do not reliably cover. The dose is the Egyptian formulary's standard adult dose for this drug; applying it to bite wounds is an extrapolation from the monograph, not a bite-specific guideline recommendation.

Cautions
  • A bite also raises rabies - see Post-Exposure Rabies Prophylaxis (Animal Bite).
  • Bite wounds are high-risk for tetanus under the classification above.
Egyptian brands
Egyptian brandManufacturerIndicative price
E-MOXCLAV 1G 10 F.C. TAB.EIPICO14.00 EGP (1.40/unit)
AUJED 625 MG 12 F.C. TAB.SIGMA TEC > JEDCO INT. CO. FOR PHARMACEUTICALS19.20 EGP (1.60/unit)
E-MOXCLAV 375MG 10 F.C. TAB.EIPICO20.40 EGP (2.04/unit)
MAGNABIOTIC 625MG 8 TAB.SEDICO37.00 EGP (4.62/unit)
CURAM 625MG 12 F.C.TAB.SANDOZ > NOVARTIS108.00 EGP (9.00/unit)
AUGMENTIN 625 MG 10 F.C.TABS.MUP > SMITHKLINE BEECHAM117.00 EGP (11.70/unit)
CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS.RAMEDA > ORGANOPHARMA106.00 EGP
AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETSGLAXO SMITHKLINE169.00 EGP
LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML? strength differs? different route - not oral solidMISR > AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.8.00 EGP
MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML? strength differs? different route - not oral solidCID8.00 EGP

ADD FOR A PURULENT WOUND OR MRSA RISK

5

CO-TRIMOXAZOLE

Add for a purulent wound or MRSA risk

2nd line

Formoral.solid

Adult dose and duration

800 mg/160 mg twice daily x 5 days

Paediatric dose

6-12 mg/kg/day [child max 320 mg]

(6 to 12 mg trimethoprim/kg/day in divided doses every 12 hours; maximum single dose 160 mg trimethoprim (Egyptian National Drug Formulary - Antimicrobial 2023).)

Dose by weight
3kg18-36 mg/day
4kg24-48 mg/day
5kg30-60 mg/day
6kg36-72 mg/day
7kg42-84 mg/day
8kg48-96 mg/day
9kg54-108 mg/day
10kg60-120 mg/day
11kg66-132 mg/day
12kg72-144 mg/day
13kg78-156 mg/day
14kg84-168 mg/day
15kg90-180 mg/day
16kg96-192 mg/day
17kg102-204 mg/day
18kg108-216 mg/day
19kg114-228 mg/day
20kg120-240 mg/day
21kg126-252 mg/day
22kg132-264 mg/day
23kg138-276 mg/day
24kg144-288 mg/day
25kg150-300 mg/day
26kg156-312 mg/day
27kg162-320 mg/day (upper capped)
28kg168-320 mg/day (upper capped)
29kg174-320 mg/day (upper capped)
30kg180-320 mg/day (upper capped)
31kg186-320 mg/day (upper capped)
32kg192-320 mg/day (upper capped)
33kg198-320 mg/day (upper capped)
34kg204-320 mg/day (upper capped)
35kg210-320 mg/day (upper capped)
36kg216-320 mg/day (upper capped)
37kg222-320 mg/day (upper capped)
38kg228-320 mg/day (upper capped)
39kg234-320 mg/day (upper capped)
40kg240-320 mg/day (upper capped)
41kg246-320 mg/day (upper capped)
42kg252-320 mg/day (upper capped)
43kg258-320 mg/day (upper capped)
44kg264-320 mg/day (upper capped)
45kg270-320 mg/day (upper capped)
46kg276-320 mg/day (upper capped)
47kg282-320 mg/day (upper capped)
48kg288-320 mg/day (upper capped)
49kg294-320 mg/day (upper capped)
50kg300-320 mg/day (upper capped)
Dose source

Cellulitis and erysipelas - disease-level clinical article (cellulitis-clinical.txt) for the indication; the paediatric weight band is from Egyptian National Drug Formulary - Antimicrobial 2023 (sulfamethoxazole and trimethoprim monograph): "6 to 12 mg TMP/kg/day in divided doses every 12 hours; maximum single dose: 160 mg TMP/dose", which the clinical article does not carry.

Why

Add when the wound is purulent, when an abscess is present, or where there are MRSA risk factors - the source pairs it with the cephalosporin rather than replacing it.

Cautions
  • Avoid in the third trimester of pregnancy and in infants under 6 weeks.
  • Drainage, not antibiotics, is the treatment for an abscess. Antibiotics are the addition.
Egyptian brands
Egyptian brandManufacturerIndicative price
CO-TRIMOXAZOLE 20 TABS.MUP5.00 EGP (0.25/unit)
COTRIL 400/80MG 20 TAB.EL NASR38.00 EGP (1.90/unit)
SEPTAZOLE FORTE 800/160MG 20 TABS.ALEXANDRIA56.00 EGP (2.80/unit)
SEPTRIN D.S 10 TABS.GLAXO SMITHKLINE > ASPEN PHARMA TRADING LIMITED28.00 EGP (2.80/unit)
SEPTAZOLE 400/80MG 20*10 TABS.ALEXANDRIA340.00 EGP (34.00/unit)
SUTRIM 400/80MG 20*10 TAB.MEMPHIS340.00 EGP (34.00/unit)
CO-TRIMOXAZOLE 200/40MG SUSP. 120ML? strength differs? different route - not oral solidMUP6.00 EGP
SUTRIM 200/40MG SUSP. 100ML? strength differs? different route - not oral solidMEMPHIS18.50 EGP

IF SEVERELY BETA-LACTAM ALLERGIC

6

CLINDAMYCIN

If severely beta-lactam allergic

2nd line

Formoral.solid

Adult dose and duration

300-450 mg every 6 hours x 5-7 days

Paediatric dose

8-20 mg/kg/day

Dose by weight
3kg24-60 mg/day
4kg32-80 mg/day
5kg40-100 mg/day
6kg48-120 mg/day
7kg56-140 mg/day
8kg64-160 mg/day
9kg72-180 mg/day
10kg80-200 mg/day
11kg88-220 mg/day
12kg96-240 mg/day
13kg104-260 mg/day
14kg112-280 mg/day
15kg120-300 mg/day
16kg128-320 mg/day
17kg136-340 mg/day
18kg144-360 mg/day
19kg152-380 mg/day
20kg160-400 mg/day
21kg168-420 mg/day
22kg176-440 mg/day
23kg184-460 mg/day
24kg192-480 mg/day
25kg200-500 mg/day
26kg208-520 mg/day
27kg216-540 mg/day
28kg224-560 mg/day
29kg232-580 mg/day
30kg240-600 mg/day
31kg248-620 mg/day
32kg256-640 mg/day
33kg264-660 mg/day
34kg272-680 mg/day
35kg280-700 mg/day
36kg288-720 mg/day
37kg296-740 mg/day
38kg304-760 mg/day
39kg312-780 mg/day
40kg320-800 mg/day
41kg328-820 mg/day
42kg336-840 mg/day
43kg344-860 mg/day
44kg352-880 mg/day
45kg360-900 mg/day
46kg368-920 mg/day
47kg376-940 mg/day
48kg384-960 mg/day
49kg392-980 mg/day
50kg400-1000 mg/day
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023

Why

The route for a patient with a severe beta-lactam allergy, and it also covers MRSA.

Cautions
  • Carries the highest Clostridioides difficile risk of the options here; warn about diarrhoea.
Egyptian brands
Egyptian brandManufacturerIndicative price
ADCOCLINDACE 150 MG 16 CAPS.ARAB DRUG COMPANY (ADCO)14.50 EGP (0.91/unit)
ALFACLINDAMYCIN 150 MG 10 CAPS.ATCO PHARMA > ROTABIOGEN14.50 EGP (1.45/unit)
ADCOCLINDACE 300 MG 16 CAPS.ARAB DRUG COMPANY (ADCO)24.00 EGP (1.50/unit)
CLINACYN 300MG 16 CAPS.SIGMA > EGYPTIAN PHARMACISTS COMPANY31.50 EGP (1.97/unit)
MEPACLIND 150MG 16 CAPS.MEPACO48.00 EGP (3.00/unit)
MEPACLIND 300MG 8 CAPS.MEPACO38.00 EGP (4.75/unit)
ALFACLINDAMYCIN 300 MG 10 CAPS.ATCO PHARMA > ROTABIOGEN69.00 EGP (6.90/unit)
DALACIN C 300MG 10 CAPS.PFIZER114.00 EGP (11.40/unit)
KLENDABIOTICAM 1 % TOP. SOLUTION? strength differs? different route - not oral solidPANAX PHARMA8.50 EGP
ADCOCLINDACE 10MG/ML TOP. SOL.? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)12.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.