From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Cellulitis in hospice patients should be treated with a goal-oriented approach that balances infection control with comfort care, prioritizing quality of life over complete resolution of infection. The recommended first-line treatment is oral antibiotics, typically cephalexin 500mg four times daily or clindamycin 300-450mg three times daily for 5-7 days, as supported by the most recent study on cellulitis treatment 1. For more severe cases, consider amoxicillin-clavulanate 875/125mg twice daily. Duration can be shortened based on clinical response and goals of care. Intravenous antibiotics like ceftriaxone 1-2g daily may be appropriate for patients with severe infection who wish to avoid hospitalization but can receive home infusions.
Alongside antibiotics, supportive measures are essential:
- Elevate the affected limb
- Provide adequate pain management with acetaminophen or opioids as needed
- Apply warm compresses Regular wound care with gentle cleansing and appropriate dressings helps manage associated wounds. The treatment approach should be individualized based on the patient's prognosis, goals of care, and symptom burden, as emphasized in the context of hospice and palliative care 2.
It's worth noting that the presence of bacterial infection in terminally ill patients does not significantly decrease patient survival, and appropriate management of infection can enhance palliative symptom control 3. Additionally, studies have shown that antibiotics with activity against community-associated MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, may be preferred empiric therapy for outpatients with cellulitis in the community-associated MRSA-prevalent setting 4, but the most recent and highest quality study on the topic did not find a significant difference in clinical cure rates between cephalexin plus trimethoprim-sulfamethoxazole and cephalexin alone 5.
Therefore, the focus should remain on providing comfort and reducing symptom burden, rather than solely on eradicating the infection, in line with the principles of hospice and palliative care.