From the Guidelines
Treatment for cellulitis typically involves antibiotics, with the specific regimen depending on severity, and the most recent guidelines recommend a 5-day course of antimicrobial therapy for uncomplicated cases, which can be extended if the infection has not improved within this time period 1.
Key Considerations
- For mild cases, oral antibiotics like cephalexin, dicloxacillin, or clindamycin for 5-10 days are usually effective.
- More severe cases may require intravenous antibiotics such as cefazolin or vancomycin in a hospital setting.
- Elevation of the affected area, application of warm compresses, and over-the-counter pain relievers like acetaminophen or ibuprofen can help reduce swelling and improve blood circulation.
- Patients should monitor the infection by marking the border of the redness with a pen and seek immediate medical attention if fever persists beyond 48 hours of antibiotic treatment, the redness expands, or pain worsens significantly.
Antibiotic Options
- Oral antibiotics: cephalexin (500 mg four times daily), dicloxacillin (500 mg four times daily), or clindamycin (300-450 mg three times daily) 1.
- Intravenous antibiotics: cefazolin (1-2 g every 8 hours) or vancomycin (15-20 mg/kg every 12 hours) 1.
Special Considerations
- For patients with suspected MRSA infection, empirical therapy with vancomycin or another antimicrobial effective against both MRSA and streptococci is recommended 1.
- For hospitalized patients with complicated SSTI, broad-spectrum antimicrobial coverage may be considered, and vancomycin plus either piperacillin-tazobactam or imipenem-meropenem is recommended as a reasonable empiric regimen 1.
From the Research
Treatment Options for Cellulitis
The treatment options for cellulitis include:
- Antibiotic therapy, with the choice of antibiotic depending on the severity of the infection and the presence of methicillin-resistant Staphylococcus aureus (MRSA) [ 2 ]
- Oral antibiotics, such as trimethoprim-sulfamethoxazole, cephalexin, or clindamycin, which have been shown to be effective in treating cellulitis [ 2 ]
- Intravenous antibiotics, which may be used in more severe cases of cellulitis, although the evidence suggests that oral antibiotics are just as effective [ 3 ]
- Narrow-spectrum antibiotics, which may be preferred over broad-spectrum antibiotics in uncomplicated cases of cellulitis [ 4 ]
Factors Affecting Treatment Outcome
The following factors can affect the outcome of treatment for cellulitis:
- Severity of the infection, with more severe cases requiring longer treatment durations [ 2 ]
- Presence of MRSA, which may require the use of antibiotics with activity against MRSA [ 2 ]
- Patient compliance with antibiotic therapy, which is essential for effective treatment [ 2 ]
Duration of Antibiotic Therapy
The optimal duration of antibiotic therapy for cellulitis is not well established, although the evidence suggests that treatment durations of longer than 5 days do not result in additional benefits [ 3 ]