Antibiotic, Steroid & Hyaluronidase Use Policy (Post-Thread Complications)

Published:

November 4, 2025

Executive Summary

This policy provides a comprehensive, evidence-based framework for the pharmacologic management of post-thread complications including infection, granuloma, and vascular occlusion. It aligns with Australian healthcare standards and integrates guidance from AHPRA, TGA, RACGP, NSW Health, ACSQHC, and WHO for clinical safety and governance oversight.

Purpose & Scope

Defines the governance and clinical pathway for registered practitioners managing complications following PDO and PLLA thread procedures in Australia, ensuring alignment with therapeutic standards and quality assurance frameworks.

Legal & Regulatory Framework

Compliant with AHPRA, TGA, RACGP, NSW Health, ACSQHC, and WHO infection management standards to maintain high governance and patient safety outcomes.

Clinical Background

Thread-related complications can include microbial infection, delayed inflammatory granuloma, and vascular occlusion in filler-thread overlap zones. The risk increases with suboptimal asepsis, re-use of cannula paths, or mixed filler types. Correct pharmacologic escalation mitigates morbidity.

Escalation & Management Algorithm

Presentation	Immediate Action	Pharmacologic Intervention	Escalation Step	Referral Trigger
Infection	Swab + photograph	Cephalexin 500 mg QID × 7d¹	If no response → Augmentin 875/125 mg BID × 7d	Systemic symptoms → Hospital review²
Granuloma	Assess for biofilm	Prednisolone 10–20 mg daily × 7d³	Re-evaluate 48h → Hyaluronidase if persistent	Nodule >14 days → Dermatology referral
Vascular Occlusion	Stop injection immediately	Hyaluronidase 1500 U/mL⁴	Warm compress + aspirin 300 mg daily	Vision change → Ophthalmology

Antibiotic Protocol

First-line: Cephalexin 500 mg QID × 7 days for Gram-positive coverage¹.
Second-line: Amoxicillin–clavulanate 875/125 mg BID × 7 days².
MRSA risk: Trimethoprim–sulfamethoxazole 160/800 mg BID × 7 days³.
Topical: Mupirocin 2% BID for localised lesions⁴.
Avoid dual therapy >10 days to reduce resistance⁶.

Corticosteroid Protocol

Prednisolone 10–20 mg daily × 7 days³.
Intralesional Triamcinolone 2.5–10 mg/mL if fibrotic⁷.
Taper by 5 mg every 2 days⁸.
Avoid in active infection, diabetes, thin skin zones⁹.

Hyaluronidase Protocol

Dose: 1500 U diluted in 1 mL saline, inject 30 U per point⁴.
Repeat every 30–60 min until reperfusion⁵.
Adjunct: Aspirin 300 mg daily, warm compress, massage⁵.
Observe hourly for 6 hours, reassess capillary refill¹⁰.

Governance & Quality Assurance

Adverse event audit annually per ACSQHC. Practitioners require credentialing and continuing education per AHPRA and RACGP frameworks.

Sources

Therapeutic Guidelines Limited (2024), Antibiotic – Version 17, viewed 04 November 2025, https://www.tg.org.au/products/therapeutic-guidelines/updates/antibiotic/ ↩
Corrected citation: World Health Organization (WHO) (2019), Antimicrobial Stewardship Programmes in Health-care Facilities in Low- and Middle-Income Countries: A WHO Practical Toolkit, viewed 04 November 2025, https://www.who.int/publications/i/item/9789241515481 ↩
DermNet NZ (2025), Systemic (oral) corticosteroids in dermatology, viewed 04 November 2025, https://dermnetnz.org/topics/systemic-steroids ↩
ACE Group World (2023), Protocol for the Management of a Vascular Occlusion Associated with Cosmetic Injections, viewed 04 November 2025, https://uk.acegroup.online/wp-content/uploads/2024/01/Vascular-Occlusion.pdf ↩
ISAPS (2024), Emergency Management of Filler Complications, viewed 04 November 2025, https://www.isaps.org/media/oogpzodr/isaps-global-survey_2024.pdf ↩
Centers for Disease Control and Prevention (2024), Antimicrobial Resistance Threats in the United States, 2021-2022, viewed 04 November 2025, https://www.cdc.gov/antimicrobial-resistance/media/pdfs/antimicrobial-resistance-threats-update-2022-508.pdf ↩
American Society for Dermatologic Surgery (ASDS) (2021), Preventing and Treating Adverse Events of Injectable Fillers: Evidence-Based Recommendations from the ASDS Multidisciplinary Task Force, viewed 04 November 2025, https://www.asds.net/Portals/0/PDF/asdsa/Preventing%20and%20Treating%20Adverse%20Events%20of%20Injectable%20Fillers%20Evidence-Based%20Recs%20From%20ASDS%20Task%20Force%20Article.pdf ↩
UpToDate (2024), Approach to discontinuing systemic glucocorticoid therapy in adults and children, viewed 04 November 2025, https://www.uptodate.com/contents/approach-to-discontinuing-systemic-glucocorticoid-therapy-in-adults-and-children ↩
Mayo Clinic (2025), Prednisone – Clinical Pharmacology, viewed 04 November 2025, https://www.mayoclinic.org/drugs-supplements/prednisone-oral-route/clinical-pharmacology/drg-20075269 ↩
Kroumpouzos G et al. (2024), Hyaluronidase for dermal filler complications, Dermatology Practical & Conceptual, (open access), viewed 04 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10836581/ ↩

Disclaimer for Newcastle Cosmetic Doctor Policies & Procedures

The policies and procedures contained within this document are the exclusive property of Newcastle Cosmetic Doctor and are provided for internal clinical governance and educational purposes only. These materials represent the internal operational framework, safety standards, and evidence-based protocols developed and implemented by Dr. Bart John Scanlon and the Newcastle Cosmetic Doctor team. They are designed specifically for use within Newcastle Cosmetic Doctor and reflect our clinic’s own professional standards, risk assessments, and compliance obligations under Australian law and regulatory authorities. External individuals, practitioners, or organisations must not copy, reproduce, distribute, or rely upon these materials, in whole or in part, for their own clinical, commercial, or educational use without prior written consent from Newcastle Cosmetic Doctor. These materials do not constitute medical, legal, or professional advice and are not intended to be adopted as official protocols or procedures by any other entity. Any external use or adaptation must be independently reviewed and modified to meet the relevant laws, guidelines, and standards applicable to the user’s own jurisdiction, scope of practice, and facility operations. Newcastle Cosmetic Doctor and Dr. Bart Scanlon accept no liability for any loss, injury, or damage arising from the unauthorised use, reliance upon, or misinterpretation of this material.