From the Guidelines
The standard treatment for cellulitis is empiric antibiotic therapy targeting the most common causative organisms, primarily beta-hemolytic streptococci and Staphylococcus aureus, 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 uncomplicated cellulitis, oral antibiotics such as cephalexin, dicloxacillin, or clindamycin are typically effective 1.
- In areas with high MRSA prevalence, trimethoprim-sulfamethoxazole (TMP-SMX) or doxycycline may be preferred 1.
- For severe infections or those with systemic symptoms, intravenous antibiotics like cefazolin, oxacillin, or vancomycin are recommended, with transition to oral therapy once clinical improvement occurs 1.
Supportive Measures
- Elevation of the affected area, pain management, and proper wound care if applicable are important supportive measures 1.
- Patients should monitor for spreading redness, increasing pain, fever, or streaking from the infection site, which may indicate worsening infection requiring medical reassessment.
Antibiotic Selection
- The choice of antibiotic should be guided by local resistance patterns, patient allergies, and risk factors for resistant organisms 1.
- Clindamycin, TMP-SMX, doxycycline, and linezolid are options for empirical coverage of CA-MRSA 1.
From the Research
Standard Treatment of Cellulitis
The standard treatment of cellulitis typically involves the use of antibiotics, with the choice of antibiotic depending on the severity of the infection and the presence of certain risk factors.
- For non-purulent, uncomplicated cases of cellulitis, antibiotics such as penicillin, amoxicillin, and cephalexin are often sufficient 2.
- 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.
- However, some studies have found that the addition of trimethoprim-sulfamethoxazole to cephalexin does not improve outcomes in patients with cellulitis without abscesses 4.
- A systematic review and meta-analysis found that there is no evidence to support the superiority of any one antibiotic over another, and that antibiotics with activity against MRSA do not add an advantage 5.
Factors Influencing Treatment Choice
The choice of antibiotic treatment for cellulitis may be influenced by several factors, including:
- The severity of the infection, with more severe cases requiring broader-spectrum antibiotics 3, 6.
- The presence of risk factors, such as diabetes, immunosuppression, or peripheral vascular disease, which may require more aggressive treatment 2.
- The likelihood of MRSA infection, with higher likelihoods requiring antibiotics with activity against MRSA 6.
- The cost-effectiveness of different antibiotic regimens, with cephalexin being the most cost-effective option in many cases 6.