What is the treatment for cellulitis?

From the Guidelines

Cellulitis should be treated with a 5- to 6-day course of antibiotics active against streptococci, particularly for patients able to self-monitor and who have close follow-up with primary care. The choice of antibiotic depends on the severity of the infection and the presence of any underlying conditions. For mild cases, oral antibiotics such as cephalexin (500 mg four times daily), dicloxacillin (500 mg four times daily), or clindamycin (300-450 mg three times daily) are usually effective 1. More severe cases may require intravenous antibiotics such as cefazolin (1-2 g every 8 hours) or vancomycin (15-20 mg/kg every 12 hours) in a hospital setting. It's also important to elevate the affected area, rest, and take over-the-counter pain relievers like acetaminophen or ibuprofen as needed. Keeping the area clean by gently washing with soap and water, and applying a sterile bandage if there are open wounds, can also help promote healing. Warm compresses can help improve circulation and reduce pain. Patients should seek immediate medical attention if fever develops, the affected area expands rapidly, or if red streaks appear extending from the infection site.

Some key points to consider when treating cellulitis include:

• The use of antibiotics active against streptococci, such as penicillin, amoxicillin, or clindamycin 1
• The consideration of empirical coverage for MRSA in patients with severe infection or those who do not respond to initial therapy 1
• The importance of elevating the affected area and keeping it clean to promote healing 1
• The use of warm compresses to improve circulation and reduce pain 1

It's also important to note that the duration of antibiotic therapy for cellulitis is typically 5-7 days, but may need to be extended if the infection has not improved after 5 days 1. Overall, the goal of treatment is to eliminate the infection, reduce inflammation, and promote healing, while also minimizing the risk of complications and improving patient outcomes.

From the FDA Drug Label

The majority of cases were subsequently categorized as complicated cellulitis, major abscesses, or traumatic wound infections. Clinical success rates in the ITT population were 62.5% (165/264) in patients treated with daptomycin for injection and 60. 9% (162/266) in patients treated with comparator drugs. Clinical success rates in the CE population were 76.0% (158/208) in patients treated with daptomycin for injection and 76.7% (158/206) in patients treated with comparator drugs. The recommended dosage for ZYVOX formulations for the treatment of infections is described in Table 14. Complicated skin and skin structure infections: 10 mg/kg IV or oral q8h, 600 mg IV or oral q12h, 10 to 14 days.

Cellulitis Treatment:

• Daptomycin for injection can be used to treat complicated skin and skin structure infections, including cellulitis, with a clinical success rate of 62.5% to 76.0% 2.
• Linezolid (ZYVOX) can be used to treat complicated skin and skin structure infections, including cellulitis, with a recommended dosage of 10 mg/kg IV or oral q8h or 600 mg IV or oral q12h for 10 to 14 days 3.
• The choice of treatment depends on the severity of the infection, the causative pathogen, and the patient's clinical response.
• It is essential to note that these treatments are for complicated skin and skin structure infections, and the treatment of uncomplicated cellulitis may differ.

From the Research

Cellulitis Treatment Overview

• Cellulitis is a common condition that can be treated with antibiotics, with the choice of antibiotic and route of administration depending on the severity of the condition 4, 5, 6, 7.
• The most commonly prescribed oral antibiotic for noncomplicated, nonfacial cellulitis is cephalexin, a first-generation cephalosporin 4.
• Intravenous antibiotics, such as cefazolin, may be used for more severe cases or for patients who have received antibiotics prior to treatment 4, 5.

Antibiotic Route and Duration of Therapy

• There is no significant difference in recovery rates between oral and intravenous antibiotic therapy for patients with cellulitis of similar severity 5, 6.
• Treatment with oral antibiotics is effective and requires fewer visits and less time in the emergency department compared to intravenous treatment 4.
• The duration of antibiotic therapy does not appear to affect outcome, with no association between duration of treatment and clinical outcome at day 10 and day 30 5, 6.

Efficacy and Safety of Antibiotics

• No single antibiotic has been shown to be superior to others in the treatment of cellulitis, and antibiotics with activity against methicillin-resistant Staphylococcus aureus do not add an advantage 6, 7.
• Cefaclor has been identified as having a favorable profile for curative outcomes in cellulitis, while ceftriaxone has the fewest gastrointestinal side effects 7.
• Pristinamycin has been shown to have the highest cure rates for erysipelas, but with a higher risk of rash 7.