From the Guidelines
Cellulitis of the leg should be treated with antibiotics active against streptococci, such as penicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, cephalexin, or clindamycin, for a duration of 5 days if clinical improvement occurs by then, as recommended by the Infectious Diseases Society of America 1.
Key Considerations
- The choice of antibiotic depends on the severity of the infection and the presence of any underlying conditions.
- For mild cases, oral antibiotics are sufficient, while severe cases may require intravenous antibiotics in a hospital setting.
- Elevation of the affected leg above heart level and warm compresses can help reduce swelling and improve circulation.
- Adequate pain management with acetaminophen or ibuprofen is also recommended.
Treatment Options
- Oral antibiotics: cephalexin (500 mg four times daily), dicloxacillin (500 mg four times daily), or amoxicillin-clavulanate (875/125 mg twice daily) for 5-10 days.
- Intravenous antibiotics: cefazolin (1-2 g every 8 hours) or vancomycin (15-20 mg/kg every 12 hours) for severe cases.
Important Notes
- It is crucial to complete the full course of antibiotics even if symptoms improve quickly.
- Patients should seek immediate medical attention if fever develops, the redness spreads, or pain worsens, as these may indicate the infection is worsening.
- Coverage for MRSA may be prudent in cellulitis associated with penetrating trauma, especially from illicit drug use, purulent drainage, or with concurrent evidence of MRSA infection elsewhere, as suggested by the Infectious Diseases Society of America 1.
From the Research
Treatment for Cellulitis of the Leg
The treatment for cellulitis of the leg typically involves the use of antibiotics, as the condition is usually caused by a bacterial infection.
- The majority of non-purulent, uncomplicated cases of cellulitis are caused by β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus 2.
- Antibiotic selection is determined by patient history and risk factors, severity of clinical presentation, and the most likely microbial culprit 3.
- Oral antibiotics such as penicillin, amoxicillin, and cephalexin are often used to treat cellulitis, with the specific choice of antibiotic depending on the severity of the infection and the patient's medical history 2.
Antibiotic Route and Duration
- There is no evidence of difference in clinical response rates for antibiotic route or duration, with oral and intravenous antibiotics being equally effective 4.
- The duration of antibiotic treatment for cellulitis is typically 5-10 days, but may vary depending on the severity of the infection and the patient's response to treatment 4.
Community-Based Treatment
- Community nurses play an important role in caring for patients with cellulitis, including dressing leg ulcers and referring patients for appropriate treatment 5.
- Outpatient antibiotic therapy (OPAT) may be used to treat cellulitis in patients who do not require hospitalization, with community nurses often involved in the delivery of this treatment 5.