From the Guidelines
For the evaluation of cellulitis of the arm, a thorough physical examination and assessment of systemic symptoms are crucial, but the use of ultrasound is not typically recommended as a first-line diagnostic tool 1. Instead, the diagnosis is primarily clinical, based on the presence of erythema, swelling, warmth, and tenderness. Blood tests, including complete blood count and blood cultures, may be warranted if severe infection is suspected. The management of cellulitis involves empiric oral antibiotic therapy, with options such as cephalexin or dicloxacillin for 5-7 days for uncomplicated cases 1. It's also important to elevate the affected arm and apply warm compresses to reduce swelling. Patients should monitor for worsening symptoms, which would necessitate prompt medical reassessment. The choice of antibiotic should cover the common causative organisms, primarily beta-hemolytic streptococci and Staphylococcus aureus. Some key points to consider in the management of cellulitis include:
- The importance of assessing the severity of the infection and the presence of systemic symptoms to guide the choice of antibiotic therapy 1.
- The role of underlying conditions, such as venous insufficiency or lymphedema, in predisposing to cellulitis and potentially affecting treatment outcomes 1.
- The potential benefits of adjunctive therapies, such as elevation of the affected limb and warm compresses, in reducing symptoms and promoting recovery. Overall, the management of cellulitis of the arm should prioritize a thorough clinical evaluation, appropriate antibiotic therapy, and supportive care to reduce symptoms and prevent complications.
From the Research
Diagnosis and Evaluation of Cellulitis
- Cellulitis is an infection of the deep dermis and subcutaneous tissue, presenting with expanding erythema, warmth, tenderness, and swelling 2.
- The diagnosis of cellulitis is based primarily on history and physical examination 2, 3.
- Point-of-care ultrasound can be a useful tool in unclear cases to differentiate cellulitis and abscess 4.
Treatment of Cellulitis
- Treatment for cellulitis typically involves a penicillin or cephalosporin, with dicloxacillin or cephalexin being the oral therapy of choice when methicillin-resistant Staphylococcus aureus is not a concern 5, 3.
- Most patients can be treated as an outpatient with oral antibiotics, with the majority of non-purulent, uncomplicated cases caused by β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus 5, 3.
- The mean time to clinical response to antibiotic treatment is approximately 1.68 days, with a 50% reduction of pain and severity score by day 5, and a 30-50% reduction of proportion of patients with edema by day 2-4 6.
Ultrasound Evaluation for Cellulitis
- Point-of-care ultrasound can be used to evaluate cellulitis, particularly in cases where the diagnosis is unclear or to differentiate cellulitis from abscess 4.
- There is no specific recommendation for the type of ultrasound to use for cellulitis of the arm, but point-of-care ultrasound is a useful tool in the emergency department setting 4.