From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci Serious skin and soft tissue infections; septicemia; Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin
The best antibiotic for lower leg cellulitis secondary to venostasis dermatitis is not explicitly stated in the provided drug labels. However, based on the available information, clindamycin may be considered for the treatment of serious skin and soft tissue infections, including those caused by streptococci, pneumococci, and staphylococci 1.
- It is essential to perform bacteriologic studies to determine the causative organisms and their susceptibility to clindamycin.
- The treatment should be guided by the results of these studies and the clinical judgment of the physician.
- Flucloxacillin may also be considered for the treatment of staphylococcal infections, but its use should be based on the results of bacteriologic studies and the severity of the infection 2.
From the Research
For lower leg cellulitis secondary to venostasis dermatitis, cephalexin (Keflex) 500 mg orally four times daily for 5-7 days is typically the first-line antibiotic treatment, as recommended by the most recent and highest quality study 3. This regimen effectively targets the most common causative organisms, primarily beta-hemolytic streptococci and Staphylococcus aureus. Some key points to consider in the treatment of lower leg cellulitis include:
- If MRSA is suspected based on risk factors or local prevalence, consider clindamycin 300-450 mg orally four times daily or trimethoprim-sulfamethoxazole (Bactrim DS) one tablet twice daily 4.
- For patients with penicillin allergies, clindamycin or doxycycline 100 mg twice daily are appropriate alternatives.
- In addition to antibiotics, elevation of the affected limb, compression therapy once the acute infection resolves, and proper skin care are essential components of treatment.
- Moisturizing the skin regularly helps maintain the skin barrier function and prevents recurrence.
- If there's no improvement within 48-72 hours of antibiotic therapy, reassessment is necessary to consider broader coverage or intravenous antibiotics.
- Addressing the underlying venous insufficiency through long-term compression therapy is crucial for preventing recurrent episodes of cellulitis in these patients 5. It's also important to note that the diagnosis of cellulitis can be challenging due to the presence of non-infectious mimickers such as venous stasis dermatitis, contact dermatitis, eczema, lymphedema, and erythema migrans 3. Overall, the treatment of lower leg cellulitis secondary to venostasis dermatitis requires a comprehensive approach that includes antibiotic therapy, wound care, and management of the underlying venous insufficiency.