From the Guidelines
Facial cellulitis treatment typically requires antibiotics active against streptococci, with a recommended duration of 5 days, but treatment should be extended if the infection has not improved within this time period 1.
Key Considerations
- For mild to moderate cases, oral antibiotics such as cephalexin, dicloxacillin, or amoxicillin-clavulanate are suitable options 1.
- In cases of uncomplicated cellulitis, a 5-day course of antimicrobial therapy is as effective as a 10-day course, if clinical improvement has occurred by 5 days 1.
- For severe cases or those with systemic symptoms like fever, intravenous antibiotics may be necessary, often including ceftriaxone, vancomycin, or clindamycin, administered in a hospital setting 1.
- Supportive measures include elevating the head while sleeping, applying warm compresses to the affected area, and taking over-the-counter pain relievers like acetaminophen or ibuprofen for discomfort.
- Adequate hydration and rest are also important for recovery.
Important Evidence
- The Infectious Diseases Society of America recommends that typical cases of cellulitis without systemic signs of infection should receive an antimicrobial agent that is active against streptococci (strong, moderate) 1.
- Cultures of blood or cutaneous aspirates, biopsies, or swabs are not routinely recommended (strong, moderate), but may be considered in certain patient populations 1.
- Vancomycin or another antimicrobial effective against both MRSA and streptococci is recommended for patients with penetrating trauma, evidence of MRSA infection elsewhere, or severe nonpurulent infections (strong, moderate) 1.
Patient Care
- Patients should be monitored closely for signs of improvement or worsening of symptoms, and the antibiotic regimen may need adjustment based on bacterial sensitivity.
- Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended (strong, moderate) 1.
- Outpatient therapy is recommended for patients who do not have SIRS, altered mental status, or hemodynamic instability (strong, moderate) 1.
From the Research
Treatment Options for Facial Cellulitis
- The treatment of facial cellulitis typically involves the use of antibiotics, with the choice of antibiotic depending on the suspected causative organism 2, 3, 4.
- For non-purulent, uncomplicated cases of cellulitis, oral antibiotics such as penicillin, amoxicillin, and cephalexin are often sufficient 2.
- However, in areas with a high prevalence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections, antibiotics with activity against MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, may be preferred 3, 5.
- A study on facial cellulitis found that β-haemolytic streptococci (BHS) were the leading cause of the infection, and that narrow-spectrum β-lactam antibiotics were effective in treating the condition 4.
Antibiotic Choices
- Trimethoprim-sulfamethoxazole has been shown to have a higher treatment success rate than cephalexin for outpatient treatment of cellulitis 3.
- Clindamycin has been found to be effective in treating MRSA infections, including those causing cellulitis 3, 5.
- Linezolid, doxycycline, and minocycline have also been shown to be effective in treating MRSA skin and soft tissue infections, including cellulitis 5.
Treatment Duration and Route of Administration
- The optimal duration of antibiotic treatment for cellulitis is not well established, but treatment for 5-7 days is common 6.
- There is no clear evidence to support the use of intravenous antibiotics over oral antibiotics for the treatment of cellulitis 6.
- The choice of antibiotic and treatment duration should be individualized based on the severity of the infection, the suspected causative organism, and the patient's response to treatment 6.