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Water-related infections – advice for Prescribers

20 January 2011

The information below may not be current and is only left here for historical reference.

Clinical considerations for patients presenting with a wound infection or cellulitis related to contact with water or of sepsis where cuts and other abrasions are the likely portal of entry.


In the management of cellulitis and deeper skin infections among patients exposed to water the usual bacterial causes should be first considered (Staph aureus and Streppyogenes) and antibiotic therapy, where indicated should be targeted against them.

However, a number of less-commonly encountered water-dwelling organisms (notably Aeromonas species) may cause these infections in this circumstance.

The resulting illness may range from a superficial skin infection, to more deep, serious or systemic manifestations (myositis, sepsis +/- metastatic complications).

Patients with underlying systemic illness are particularly prone to develop the more serious manifestations.

For minor skin infections, treat as for mild early cellulitis.

For contaminated wound infections, treat as usual for contaminated wounds (see below for additional antibiotic advice).

Local management of skin lesions as per usual clinical practice may include: incision, drainage and debridement, with collection of appropriate specimens for microbiology as indicated. Assessment of the need for tetanus vaccination would also be appropriate.

Exposure to fresh water

For fresh water-related skin infections of more significant severity, an antibiotic with activity against Aeromonas sp can be added to the usual antibiotic that would be prescribed for this condition (di/flucloxacillin or clindamycin). Suitable drugs against Aeromonas sp for adults include ciprofloxacin in a dose of 500 mg PO BD, or co-trimoxazole (in the non-sulfa-allergic patient).

For children use co-trimoxazole 4 mg (0.5ml of mixture)/kg/dose 12 hourly.

For more serious infections admission to hospital for consideration of intravenous antibiotic therapy is advised. In this circumstance ciprofloxacin (400 mg IV, 12 hourly) added to the usual antibiotic would be appropriate for adults. For children use cefotaxime 50mg/kg/dose 8 hourly or ceftriaxone 50mg/kg daily IV in addition to the usual antibiotic.

Specialist advice from an Infectious Diseases Physician or Clinical Microbiologist may be appropriate.