What is the treatment for cellulitis with cephalexin (Cefalexin)?

From the Guidelines

Cephalexin is a recommended oral antibiotic option for the treatment of uncomplicated cellulitis.

Key Considerations

• The typical dosage of cephalexin for uncomplicated cellulitis is 500mg every 6 hours for 5 days, as supported by 1.
• In cases of more severe infection, the dose may be increased to 1000mg every 6 hours, but this should be done under close clinical monitoring 1.
• It is essential to note that cephalexin should be used in conjunction with close clinical monitoring to assess treatment response and adjust the duration of therapy as needed, typically not exceeding 14 days, as recommended by 1.
• The treatment of cellulitis with cephalexin should also include elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, as recommended by 1.

Important Points to Consider

• Cephalexin is effective against streptococci, which are the most common cause of cellulitis, as supported by 1.
• The use of cephalexin for the treatment of cellulitis should be based on the severity of the infection and the patient's overall health status, as recommended by 1.
• Close clinical monitoring is essential to assess treatment response and adjust the duration of therapy as needed, as supported by 1.

From the FDA Drug Label

Skin and skin structure infections caused by Staphylococcus aureus and/or Streptococcus pyogenes The treatment for cellulitis with cephalexin is approved, as cephalexin is indicated for the treatment of skin and skin structure infections caused by Staphylococcus aureus and/or Streptococcus pyogenes, which are common causes of cellulitis 2.

• Key points:
  • Cephalexin is effective against Staphylococcus aureus and Streptococcus pyogenes
  • Culture and susceptibility tests should be initiated prior to and during therapy
  • Cephalexin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria

From the Research

Treatment of Cellulitis with Cephalexin

• Cephalexin is an antibiotic that can be used to treat uncomplicated cellulitis, with a dosage of 500 mg four times daily for 7 days 3.
• The use of cephalexin plus trimethoprim-sulfamethoxazole compared to cephalexin alone did not result in higher rates of clinical resolution of cellulitis in the per-protocol analysis, but further research may be needed due to imprecision around the findings in the modified intention-to-treat analysis 3.
• A study comparing short-course (5 days) and standard (10 days) treatment for uncomplicated cellulitis found that 5 days of therapy with levofloxacin appears to be as effective as 10 days of therapy, but it did not specifically investigate cephalexin 4.
• The addition of an oral anti-inflammatory agent to antibiotic treatment, including cephalexin, significantly shortened the time to regression of inflammation and complete resolution of cellulitis 5.
• Cefadroxil, another cephalosporin antibiotic, had a clinical cure rate of 85% for uncomplicated skin and skin-structure infections, including cellulitis, which is comparable to cephalexin 6.

Duration of Treatment

• The optimal duration of treatment for uncomplicated cellulitis is not well established, but studies suggest that 5-7 days of antibiotic therapy may be sufficient 4, 5.
• A study found that the mean time to clinical response for uncomplicated cellulitis was 1.68 days, with a significant reduction in symptoms by day 2-5 7.

Combination Therapy

• The use of combination antibiotic and anti-inflammatory therapy may hasten the resolution of cellulitis-related inflammation 5.
• However, the addition of trimethoprim-sulfamethoxazole to cephalexin did not result in higher rates of clinical resolution of cellulitis in the per-protocol analysis 3.