From the Guidelines
For a patient with cellulitis of the buttock who is allergic to cefzil (cefprozil), a suitable empiric antibiotic would be clindamycin 300-450 mg orally every 6-8 hours for 5-10 days. Clindamycin provides good coverage against the most common causative organisms of cellulitis, including Staphylococcus aureus (including many MRSA strains) and Streptococcus species, as recommended by the Infectious Diseases Society of America 1. If MRSA is a significant concern in your area, trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets twice daily for 5-10 days is another option, though it has less reliable activity against Streptococcus 1. For patients with severe penicillin allergies who cannot tolerate cephalosporins, doxycycline 100 mg twice daily for 5-10 days can also be considered 1. The duration of therapy should be guided by clinical response, with most uncomplicated cases resolving within 5-7 days of treatment, as supported by a 2014 update by the Infectious Diseases Society of America 1. If the patient shows signs of systemic illness (fever, tachycardia) or has significant comorbidities, hospitalization for intravenous antibiotics may be necessary. The choice of antibiotic should also consider local resistance patterns and be adjusted based on culture results if available. Key considerations include:
- Coverage for both Staphylococcus aureus and Streptococcus species
- Local resistance patterns
- Patient's allergy history and comorbidities
- Clinical response and potential need for hospitalization
- Adjustment of antibiotic therapy based on culture results, as recommended by the Infectious Diseases Society of America 1.
From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylocci Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. Serious skin and soft tissue infections; To reduce the development of drug-resistant bacteria and maintain the effectiveness of clindamycin hydrochloride and other antibacterial drugs, clindamycin hydrochloride should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria
A suitable empiric antibiotic for a patient with cellulitis of the buttock who is allergic to cefzil (Cefprozil) is clindamycin (PO), as it is indicated for the treatment of serious skin and soft tissue infections, including those caused by streptococci and staphylococci, which are common causes of cellulitis 2.
- Key considerations:
- Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin.
- Local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
From the Research
Empiric Antibiotic Options for Cellulitis of the Buttock with Allergy to Cefzil
Given the patient's allergy to cefzil (Cefprozil), a cephalosporin antibiotic, alternative empiric antibiotic options for cellulitis of the buttock need to be considered.
- First-line treatment options: According to 3, dicloxacillin or cephalexin are the oral therapies of choice when methicillin-resistant Staphylococcus aureus (MRSA) is not a concern. However, since the patient is allergic to cefzil, a cephalosporin, cephalexin may not be suitable due to the risk of cross-reactivity.
- Alternative options:
- Penicillin or amoxicillin may be considered as alternative options, as they are effective against β-hemolytic streptococci and methicillin-sensitive Staphylococcus aureus, which are common causes of cellulitis 4.
- Clindamycin is another option, which has been shown to be effective in treating cellulitis, especially in cases where MRSA is a concern 5.
- Trimethoprim-sulfamethoxazole may also be considered, as it has been shown to have a high treatment success rate for cellulitis, especially in areas with a high prevalence of community-associated MRSA infections 5.
- Considerations: The choice of empiric antibiotic should be based on the severity of the cellulitis, the presence of risk factors for MRSA, and the patient's allergy history. It is essential to note that the diagnosis of cellulitis is primarily based on history and physical examination, and laboratory tests may not always be helpful in confirming the diagnosis 6.
In summary, suitable empiric antibiotic options for a patient with cellulitis of the buttock who is allergic to cefzil include penicillin, amoxicillin, clindamycin, or trimethoprim-sulfamethoxazole, depending on the severity of the infection and the presence of risk factors for MRSA, as suggested by 3, 6, 4, 5.