From the Guidelines
For thorn-induced cellulitis, the best antibiotics are those that cover both Staphylococcus aureus and Streptococcus species, as well as potential soil organisms, with a recommended treatment duration of 5-7 days. The choice of antibiotic should be based on the severity of the infection and the patient's ability to self-monitor and follow up with primary care 1.
First-line Treatment Options
- Cephalexin 500 mg orally four times daily for 5-7 days
- Dicloxacillin 500 mg orally four times daily
- Amoxicillin-clavulanate 875/125 mg twice daily
Alternative Treatment Options
- For patients with penicillin allergies, clindamycin 300-450 mg orally four times daily is appropriate
- If there's concern for methicillin-resistant Staphylococcus aureus (MRSA), consider trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets twice daily or doxycycline 100 mg twice daily
Severe Infections
- For severe infections requiring intravenous therapy, cefazolin, nafcillin, or vancomycin may be necessary It's essential to note that plant thorn injuries can introduce unusual pathogens, including Pseudomonas, fungi, or atypical mycobacteria, so if standard treatment fails, broader coverage or wound cultures should be considered 1. Patients should also clean the wound thoroughly, elevate the affected area, and seek medical attention if fever develops or the infection worsens despite antibiotics.
From the Research
Antibiotic Treatment for Thorn-Induced Cellulitis
- The best antibiotics for thorn-induced cellulitis are not explicitly stated in the provided studies, but some studies suggest the following antibiotics for cellulitis treatment:
- Dicloxacillin or cephalexin as the oral therapy of choice when methicillin-resistant Staphylococcus aureus (MRSA) is not a concern 2
- Trimethoprim-sulfamethoxazole, cephalexin, or clindamycin for empiric outpatient therapy 3
- Cephalexin plus trimethoprim-sulfamethoxazole or cephalexin alone for uncomplicated cellulitis 4
- Penicillin, amoxicillin, and cephalexin for non-purulent, uncomplicated cases of cellulitis caused by β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus 5
- A case study reported the use of sulbactam-ampicillin for a child with cellulitis caused by Enterobacter cloacae, which was introduced through a plant thorn injury 6
Considerations for Antibiotic Selection
- The choice of antibiotic should be based on the suspected or confirmed causative pathogen and local resistance patterns
- MRSA coverage may be necessary in some cases, but it is not generally recommended for non-purulent cellulitis 3, 5
- Imaging studies and medical history are important for diagnosing and treating cellulitis, especially in cases that do not respond to initial antibiotic therapy 6
Specific Pathogens and Antibiotics
- Enterobacter cloacae, a rare cause of cellulitis, may be introduced through plant thorn injuries and can be treated with sulbactam-ampicillin 6
- β-hemolytic streptococci and methicillin-sensitive Staphylococcus aureus are common causes of non-purulent, uncomplicated cellulitis and can be treated with penicillin, amoxicillin, or cephalexin 5