What is the treatment for cellulitis of the hand?

From the Guidelines

Hand cellulitis treatment typically requires a course of antibiotics to eliminate the bacterial infection, with oral antibiotics such as cephalexin, dicloxacillin, or amoxicillin-clavulanate being effective for mild cases, and intravenous antibiotics like cefazolin or vancomycin being necessary for more severe cases 1.

Key Considerations

• The choice of antibiotic should cover streptococci and possibly methicillin-resistant Staphylococcus aureus (MRSA) if suspected or in patients with risk factors 1.
• A 5-day course of antimicrobial therapy may be sufficient if clinical improvement occurs, but treatment should be extended if the infection has not improved within this time period 1.
• Elevation of the affected hand, warm compresses, and over-the-counter pain relievers can help manage symptoms and prevent recurrence 1.

Treatment Options

• Oral antibiotics:
  • Cephalexin (500 mg four times daily)
  • Dicloxacillin (500 mg four times daily)
  • Amoxicillin-clavulanate (875/125 mg twice daily)
• Intravenous antibiotics (for severe cases):
  • Cefazolin (1-2 g every 8 hours)
  • Vancomycin (15-20 mg/kg every 12 hours)

Important Notes

• If the infection doesn't improve within 48 hours of starting antibiotics, or if symptoms worsen, seek immediate medical attention 1.
• Proper hand hygiene and keeping any cuts or wounds clean and covered can help prevent recurrence 1.
• The most recent and highest quality study, published in 2018, recommends empiric therapy for community-acquired MRSA (CA-MRSA) in patients at risk or who do not respond to first-line therapy 1.

From the FDA Drug Label

The cure rates in clinically evaluable patients with complicated skin and skin structure infections were 90% in linezolid-treated patients and 85% in oxacillin-treated patients The cure rates by pathogen for microbiologically evaluable patients are presented in Table 18. Table 18 Cure Rates at the Test-of-Cure Visit for Microbiologically Evaluable Adult Patients with Complicated Skin and Skin Structure Infections Pathogen Cured ZYVOX n/N (%) Oxacillin/Dicloxacillin n/N (%) Staphylococcus aureus 73/83 (88) 72/84 (86) Methicillin-resistant S aureus 2/3 (67) 0/0 (-) Streptococcus agalactiae 6/6 (100) 3/6 (50) Streptococcus pyogenes 18/26 (69) 21/28 (75)

Hand cellulitis treatment can be done with linezolid, with a cure rate of 90% in clinically evaluable patients with complicated skin and skin structure infections, including those caused by Staphylococcus aureus and Streptococcus pyogenes 2.

• The recommended dosage for linezolid is 600 mg IV or oral q12h for 10 to 14 days 2.
• Linezolid can be administered orally or intravenously, and the dosage and route of administration may vary depending on the patient's age and the severity of the infection 2.

From the Research

Hand Cellulitis Treatment

• Hand cellulitis is an acute infection of the dermal and subcutaneous layers of the skin, often occurring after a local skin trauma 3.
• The clinical presentation of hand cellulitis typically includes erythema, swelling, warmth, and tenderness over the affected area 3, 4.
• The diagnosis of hand cellulitis is based on the history of present illness and physical examination, and lacks a gold standard for diagnosis 4.

Treatment Options

• Most patients with hand cellulitis can be treated as outpatients with oral antibiotics, with dicloxacillin or cephalexin being the oral therapy of choice when methicillin-resistant Staphylococcus aureus is not a concern 3.
• For non-purulent, uncomplicated cases of hand cellulitis, appropriate targeted coverage of the pathogen with oral antibiotics such as penicillin, amoxicillin, and cephalexin is sufficient 4.
• In areas with a high prevalence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections, antibiotics with activity against community-associated MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, are preferred empiric therapy for outpatients with hand cellulitis 5.

Comparison of Antibiotics

• A study comparing broad-spectrum antibiotics and narrow-spectrum antibiotics in the treatment of lower extremity cellulitis found that repeat visit due to cellulitis was similar in both groups, suggesting that broad-spectrum antibiotic use in uncomplicated cellulitis may be unjustified 6.
• An evidence-based care pathway for cellulitis was found to improve process, clinical, and cost outcomes by reducing broad-spectrum antibiotic use, pharmacy costs, and total facility costs without an adverse change in length of stay or 30-day readmissions 7.