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1
O’Meara S, Al-Khurdi D, Ovington LG. Antibiotics and antiseptics for venous leg ulcers. Cochrane Database of Systematic Reviews. 2010. Issue 1. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003557/frame.html Accessed 23.09.14. RATIONALE: Most studies identified by this Cochrane review were of poor methodological quality. Use of antibiotics did not promote healing compared to placebo in four trials of people with leg ulcers without visible signs of infection.

2
RCN The nursing management of patients with venous leg ulcers. Recommendations. Royal College of Nursing. 2006 http://www.rcn.org.uk/development/practice/clinicalguidelines/venous_leg_ulcers Accessed 23.09.14. RATIONALE: Expert consensus is that swabbing (and so by definition antibiotic therapy) is unnecessary unless there is evidence of clinical infection such as inflammation, redness, or cellulitis; increased pain; purulent exudates; rapid deterioration of the ulcer; pyrexia; or foul odour.

3
Public Health England. Investigation of skin and superficial and non-surgical wound swabs. UK Standards for Microbiology Investigations SMI B 11. Issue 5.2 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/343916/B_11i5.2.pdf Accessed 22.09.14. RATIONALE: Wound swabs should be taken from clinically infected ulcers before starting antibiotics. Taking swabs after starting antibiotics may affect the swab results. Sensitivity results can help guide the appropriate use of further antibiotics if the infection is not clinically improving on empirical treatment.

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).