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Pressure ulcer — SCE Dermatology MCQ

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HardDressings & wound carePressure ulcerSCE Dermatology

A chronic venous ulcer has increased malodorous exudate but no spreading erythema, warmth, new pain or fever. It has not received antibiotics. What is the best initial antimicrobial approach?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Do not swab or prescribe antibiotics; optimize venous treatment and review

Explanation lettering: D = shown as A · A = shown as D

B is correct. Most leg ulcers are colonised and may produce exudate or odour without invasive infection. NICE advises against microbiological sampling at initial presentation and against antibiotics unless there is spreading redness or swelling, localized warmth, increased pain or fever. Treating colonisation does not accelerate healing and selects resistance. The priority is compression when safe, oedema control, suitable dressings and reassessment. If infection subsequently fails to improve or worsens, a properly cleaned sample and antibiotic review may be appropriate. Severe disproportionate pain or systemic illness requires urgent reassessment.

Reference: NICE NG152: leg-ulcer infection antimicrobial prescribing: https://www.nice.org.uk/guidance/ng152/chapter/recommendations