acute

Pressure ulcer

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

Evidence status

Checked against the sources named below

Sources2 sources

Egyptian National Drug Formulary - antimicrobial-2023.pdf, Flucloxacillin monograph (chapter PDF p361) · Zaidi SRH, El Khatib S, Sharma S. Pressure Injury. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. NBK553107.

Verified against1 document

Egyptian National Drug Formulary - antimicrobial-2023.pdf, Flucloxacillin monograph (chapter PDF p361)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (8)

Where sensation and movement are intact, sustained pressure hurts and the person shifts position
Most who go on to develop one have impaired movement, impaired sensation, or both [numbness]
With sensation blunted or gone, the patient may have no idea the injury exists
It is usually a carer, relative or staff member who notices first, and often only once the skin has broken and discharge marks clothes or sheets
Ask how long they have been immobile or in hospital, the underlying illness, smoking, medicines, and any starting-point sensory or motor loss
Neurological or heart and vessel disease both raises the risk and lowers the chance of healing
Feeding, fluid intake, thinking ability and mobility all have to be assessed
Prevention has to weigh malnutrition, anaemia, old age, impaired thinking and peripheral vascular disease [anaemia]

Signs — what you find (12)

The commonest sites are the sacrum, the sitting bone and the greater trochanter
Also at risk: back of the head, shoulder blade, elbow, heel, outer ankle bone, shoulder and ear
Measure length, width and depth at every look, and how far the wound undermines or tunnels
Record the discharge, how wet it is, the shape and the smell; gentle palpation tells you more about an open wound
Note whether the area is painfully oversensitive or numb, and take photographs for the notes
Deep injury is easy to miss, because the skin over it usually still looks unbroken
Muscle gives way to pressure long before skin or fat, so dead tissue forms deep over a bony point while the surface still looks whole
So feel over bony points for boggy or unusually firm tissue; a change in temperature can come before any visible colour change
Wipe barrier creams off before looking, inspect the skin under and beside any medical device, and use good light or a pinpoint torch
Write down any delirium, encephalopathy, dementia or other loss of mental capacity [confusion]
A deep tissue injury looks like intact skin that does not blanch, coloured dark purple or maroon
Red flag: necrosis can spread outward into cellulitis, into the bone as osteomyelitis, or into the blood as sepsis [cellulitis · necrosis · sepsis]

Tests (9)

There is no laboratory test: assessment means judging risk, staging the injury, documenting it, and repeating that at set intervals
Three assessment scales are in wide use, Waterlow, Norton and Braden, with Braden the commonest worldwide
The six things it looks at are sensory perception, moisture, activity, mobility, nutrition, and friction and shear
Sensory perception runs from completely limited through to unimpaired
Mobility runs from completely immobile through to no limitation
Moisture runs from constantly wet through to rarely wet
Nutrition runs from very poor through to excellent
Activity runs from bedbound, to chairbound, to walking now and then or often
Friction and shear is recorded as a problem, a possible problem, or none apparent

If not this — what else fits (7)

Diabetic ulcer
Venous leg ulcer
Arterial ulcer from poor blood supply
Pyoderma gangrenosum
Calciphylaxis
Bone infection underneath (osteomyelitis)
Dermatitis of the surrounding skin

SourceStatPearls "Pressure Injury" - disease-level clinical article

Presentation findings are traced to the source above.

FLUCLOXACILLIN

2nd line

Formoral.solid

Adult dose and duration

250 mg orally (or by intramuscular injection) four times daily; the dose may be doubled for a severe infection.

Paediatric dose

Paediatric dosing is specialist-set and is not reproduced here.

Dose source

Egyptian National Drug Formulary - antimicrobial-2023.pdf, Flucloxacillin monograph (chapter PDF p361)

Why

An infected pressure ulcer is a skin and soft tissue infection typically involving staphylococci/streptococci at the wound margin; flucloxacillin at the standard skin-infection dose (with the option to double it for a more severe infection) is appropriate first-line oral empirical cover for localised infection.

Cautions

Signs of deep tissue infection, osteomyelitis, or sepsis from an infected pressure ulcer need urgent referral.
Flucloxacillin is only for a clinically infected ulcer - spreading redness/warmth, increasing pain, purulent discharge, fever - not for a colonised but clean wound, which does not need antibiotics.
Covers staphylococci/streptococci around the wound edge; if the ulcer is deep, malodorous, or not responding, suspect mixed anaerobic/Gram-negative infection or osteomyelitis and refer rather than continuing oral flucloxacillin alone.
Avoid in penicillin allergy.
Combine with pressure offloading, regular repositioning, and wound dressing - antibiotics alone do not heal a pressure ulcer.
Oral: Take flucloxacillin on an empty stomach. This means 30 to 60 minutes before a meal or snack, or at least 2 hours after.
Hepatitis and cholestatic jaundice have been reported occasionally with flucloxacillin and may be delayed in onset for up to 2 months after treatment has been stopped; older patients and those receiving flucloxacillin for more than 2 weeks are at greater risk.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
FLUMOCIN 250MG 12CAPS.! also contains amoxicillin	UP PHARMA	6.20 EGP (0.52/unit)
AMOFLUX 125/125MG 12 CAPS.! also contains amoxicillin	RAMEDA > DELTA PHARMA	8.25 EGP (0.69/unit)
FLUCAMOX 250MG 12CAPS.! also contains amoxicillin	SEDICO	8.25 EGP (0.69/unit)
FLUMOCIN 500MG 8 CAPS.! also contains amoxicillin	UP PHARMA	6.00 EGP (0.75/unit)
CURAFLUX 125/125 MG 12 CAPS.! also contains amoxicillin	RAMEDA > PIONEER	12.50 EGP (1.04/unit)
AMOFLUX 250/250MG 16 CAPS.! also contains amoxicillin	RAMEDA > PIONEER	18.00 EGP (1.12/unit)
HI-FLUCIL 250/250MG 16 CAPS.! also contains amoxicillin	CID	20.00 EGP (1.25/unit)
AMPIFLUX 500 MG 12 CAPS.! also contains ampicillin	PHARCO	16.00 EGP (1.33/unit)

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