# Pressure ulcer - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - Egyptian National Drug Formulary - antimicrobial-2023.pdf, Flucloxacillin monograph (chapter PDF p361) ## Treatment metadata - Flucloxacillin — oral.solid ## Complete treatment card ```text PRESSURE ULCER 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. Review status: REVIEWED against the source listed above (2026-08) 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 Source StatPearls "Pressure Injury" - disease-level clinical article Status traced to the source above 1. FLUCLOXACILLIN [2nd line] Adult 250 mg orally (or by intramuscular injection) four times daily; the dose may be doubled for a severe infection. Peds Paediatric dosing is specialist-set and is not reproduced here. 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. Caution 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. Egypt FLUMOCIN 250MG 12CAPS. UP PHARMA 6.20 EGP (0.52/unit) -> ! also contains amoxicillin AMOFLUX 125/125MG 12 CAPS. RAMEDA > DELT... 8.25 EGP (0.69/unit) -> ! also contains amoxicillin FLUCAMOX 250MG 12CAPS. SEDICO 8.25 EGP (0.69/unit) -> ! also contains amoxicillin FLUMOCIN 500MG 8 CAPS. UP PHARMA 6.00 EGP (0.75/unit) -> ! also contains amoxicillin CURAFLUX 125/125 MG 12 CAPS. RAMEDA > PIONEER 12.50 EGP (1.04/unit) -> ! also contains amoxicillin AMOFLUX 250/250MG 16 CAPS. RAMEDA > PIONEER 18.00 EGP (1.12/unit) -> ! also contains amoxicillin HI-FLUCIL 250/250MG 16 CAPS. CID 20.00 EGP (1.25/unit) -> ! also contains amoxicillin AMPIFLUX 500 MG 12 CAPS. PHARCO 16.00 EGP (1.33/unit) -> ! also contains ampicillin Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)