From the Guidelines
The first-line antibiotic for cellulitis in the UK is flucloxacillin, typically prescribed at a dose of 500mg four times daily for 5-7 days for adults with mild to moderate infection. This recommendation is based on the most recent guidelines from the National Institute for Health and Care Excellence (NICE) 1. For patients with penicillin allergy, clarithromycin (500mg twice daily) or doxycycline (200mg on day one, then 100mg daily) are recommended alternatives.
Key Considerations
- Flucloxacillin is preferred because it effectively targets Staphylococcus aureus and Streptococcus species, which are the most common causative organisms in cellulitis.
- Treatment should be started promptly to prevent spread of infection, and patients should be advised to rest and elevate the affected limb to reduce swelling.
- If symptoms worsen despite treatment, fever develops, or the redness continues to spread, patients should seek immediate medical attention as this may indicate treatment failure requiring antibiotic adjustment.
- The 2019 NICE guideline recommends a course of 5 to 7 days of antibiotics for uncomplicated cellulitis 1.
- In more severe cases requiring intravenous therapy, the same antibiotics may be used at higher doses or broader-spectrum antibiotics might be necessary.
Special Cases
- For patients whose cellulitis is associated with penetrating trauma or who have evidence of MRSA infection elsewhere, nasal colonization with MRSA, injection drug use, or systemic inflammatory response syndrome, inclusion of another antimicrobial effective against both MRSA and streptococci is recommended 1.
- The American College of Physicians recommends a 5- to 6-day course of antibiotics active against streptococci for patients with nonpurulent cellulitis, particularly for patients able to self-monitor and who have close follow-up with primary care 1.
From the Research
First Line Antibiotic for Cellulitis in the UK
- The first line antibiotic for cellulitis in the UK is not explicitly stated in the provided studies, but based on the information available, flucloxacillin is often used as a first-line treatment for cellulitis in some countries 2.
- However, it's essential to note that the choice of antibiotic may depend on various factors such as patient history, risk factors, severity of clinical presentation, and the most likely microbial culprit 3.
- A systematic review found that there is no significant difference in clinical response to different antibiotic types, administration routes, treatment durations, or doses for lower limb cellulitis 4.
- Another study found that antibiotic overuse is common in treating cellulitis, and there is a need for patient-tailored antibiotic prescribing to reduce unnecessary antibiotic use 5.
Antibiotic Options
- Flucloxacillin is often used in combination with penicillin V for the treatment of cellulitis, but there is no evidence to suggest that this combination is more effective than flucloxacillin alone 2.
- Ceftriaxone has been shown to be effective in treating cellulitis, particularly in children, and may be considered as an alternative to flucloxacillin 6.
- The choice of antibiotic should be based on the individual patient's needs and the severity of their condition, rather than a one-size-fits-all approach 3.