From the Guidelines
Cellulitis is less likely to develop when you maintain good skin hygiene, promptly treat skin injuries, and manage underlying conditions that increase risk, as recommended by the Infectious Diseases Society of America 1. To reduce the likelihood of cellulitis, it is essential to:
- Keep your skin clean and moisturized to prevent cracks and breaks that allow bacteria to enter
- Immediately clean any cuts, scrapes, or burns with soap and water, and apply an antibiotic ointment like bacitracin or Neosporin
- Cover wounds with clean bandages until healed
- Control conditions like diabetes, maintaining blood glucose levels within target ranges through medication adherence and lifestyle measures
- Treat fungal infections such as athlete's foot promptly with antifungal medications like clotrimazole or terbinafine
- Manage edema through elevation, compression stockings, or prescribed diuretics if recommended by your doctor
- Avoid scratching insect bites or skin conditions that could break the skin For those with recurrent cellulitis, preventive antibiotics might be prescribed, typically penicillin V 250mg twice daily or erythromycin 250mg twice daily for those with penicillin allergy, as suggested by the Infectious Diseases Society of America 1. It is also important to identify and treat predisposing conditions such as edema, obesity, eczema, venous insufficiency, and toe web abnormalities, as recommended by the Infectious Diseases Society of America 1. Additionally, elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended by the Infectious Diseases Society of America 1. The most recent guidelines from the WHO Essential Medicines and Aware recommendations suggest that amoxicillin-clavulanic acid, cloxacillin, and cefalexin are suitable first-choice antibiotics for mild skin and soft tissue infections, including cellulitis 1.
From the Research
Factors that May Reduce the Risk of Cellulitis
- Enhanced foot hygiene 2
- Applying emollients daily 2
- Exercise 2
- Losing weight 2
- Long-term, low-dose antibiotics, although this is the only proven strategy and patients often express caution about this option 2
Limitations of Current Research
- There is a lack of research on the effectiveness of non-antibiotic prevention strategies 2
- The evidence base for antibiotic treatment decisions in cellulitis is flawed by biased comparisons, short follow-up, and lack of data around harms of antibiotic overuse 3
Diagnosis and Management of Cellulitis
- Cellulitis is a clinical diagnosis based on history and physical examination, and lacks a gold standard for diagnosis 4, 5
- Antibiotic selection is determined by patient history and risk factors, severity of clinical presentation, and the most likely microbial culprit 4, 5
- The optimal time to clinical reassessment is between 2 and 4 days, but this must be interpreted with caution due to considerable heterogeneity and small number of included studies 6