What is the recommended treatment for cellulitis?

From the Guidelines

The recommended treatment for cellulitis typically involves antibiotics targeting the most common causative bacteria, primarily Streptococcus and Staphylococcus species. For mild cases, oral antibiotics such as cephalexin (500 mg four times daily), dicloxacillin (500 mg four times daily), or clindamycin (300-450 mg three times daily) for 5 days are usually effective, as a 5-day course of antimicrobial therapy is as effective as a 10-day course if clinical improvement has occurred by 5 days 1.

Key Considerations

• The choice of antibiotic may need adjustment based on local resistance patterns, patient allergies, and culture results if available.
• For more severe infections or those with systemic symptoms, intravenous antibiotics may be necessary, including cefazolin (1-2 g every 8 hours), nafcillin (1-2 g every 4-6 hours), or vancomycin (15-20 mg/kg every 8-12 hours) if MRSA is suspected 1.
• In addition to antibiotics, supportive measures are important, including elevation of the affected limb to reduce swelling, pain management with acetaminophen or ibuprofen, and keeping the area clean and dry.
• Patients should mark the border of the redness with a pen to monitor progression or improvement.
• If the infection worsens despite antibiotics, shows rapid spread, or is accompanied by high fever or severe pain, immediate medical attention is needed as this could indicate a more serious infection requiring hospitalization.

Special Cases

• For patients with systemic toxicity and/or rapidly progressive or worsening infection despite receipt of appropriate oral antibiotics, inpatient management and surgical intervention is recommended 1.
• Vancomycin plus either piperacillin-tazobactam or imipenem-meropenem is recommended as a reasonable empiric regimen for severe infections 1.
• The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period 1.

From the FDA Drug Label

The recommended dosage for ZYVOX formulations for the treatment of infections is described in Table 14. Complicated skin and skin structure infections: 10 mg/kg IV or oral q8h, 600 mg IV or oral q12h, 10 to 14 days. Uncomplicated skin and skin structure infections: <5 yrs: 10 mg/kg oral q8h, 5–11 yrs: 10 mg/kg oral q12h, Adults: 400 mg oral q12h, Adolescents: 600 mg oral q12h, 10 to 14 days.

The recommended treatment for cellulitis, which is a type of skin and skin structure infection, is linezolid (ZYVOX) 600 mg orally every 12 hours for 10 to 14 days 2.

• Dosage: 600 mg every 12 hours.
• Duration: 10 to 14 days.
• Administration: Oral. In cases of complicated skin and skin structure infections, the dosage can be adjusted to 600 mg IV or oral every 12 hours for 10 to 14 days 2.
• Dosage: 600 mg every 12 hours.
• Duration: 10 to 14 days.
• Administration: IV or oral.

From the Research

Treatment Options for Cellulitis

• The recommended treatment for cellulitis typically involves the use of antibiotics, with the specific type and duration of treatment depending on the severity and cause of the infection 3, 4, 5, 6, 7.
• For uncomplicated cellulitis, oral antibiotics such as penicillin, amoxicillin, and cephalexin are often sufficient, as they provide targeted coverage against β-hemolytic streptococci and methicillin-sensitive Staphylococcus aureus 6.
• In cases where community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is suspected, antibiotics with activity against MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, may be preferred 4.
• The route of antibiotic administration (oral vs. parenteral) does not appear to significantly impact treatment outcomes for uncomplicated cellulitis, with oral antimicrobials being as effective as parenteral antimicrobials 5, 7.
• The duration of antibiotic therapy for cellulitis is typically around 5-10 days, although the optimal duration may vary depending on the individual case and the severity of the infection 5.

Factors Influencing Treatment Success

• The severity of cellulitis, as measured by factors such as C-reactive protein levels, affected skin surface area, and systemic inflammatory response syndrome score, can influence treatment outcomes 5.
• Patient characteristics, such as obesity and presence of comorbidities, may also impact treatment success 4.
• The presence of MRSA or other resistant organisms can affect treatment outcomes and may require alternative antibiotic regimens 4, 6.

Diagnostic Considerations

• Cellulitis is a clinical diagnosis based on history and physical examination, and lacks a gold standard for diagnosis 6.
• Microbiological diagnosis is often challenging due to poor sensitivity of culture specimens, and clinical presentation with acute onset of redness, warmth, swelling, and tenderness is typical 6.
• Differentiation from pseudocellulitis, such as venous stasis dermatitis, contact dermatitis, eczema, lymphedema, and erythema migrans, is important for accurate diagnosis and treatment 6.