What is the treatment for foot cellulitis?

From the Guidelines

The treatment for foot cellulitis typically involves antibiotics, either oral or intravenous depending on severity, with a recommended duration of 5 days, but treatment should be extended if the infection has not improved within this time period 1.

Key Considerations

• For mild to moderate cases, oral antibiotics such as cephalexin, dicloxacillin, or amoxicillin-clavulanate are prescribed, with the goal of covering streptococci, as they are the most common cause of cellulitis 1.
• Severe cases may require hospitalization and intravenous antibiotics like cefazolin or vancomycin if MRSA is suspected, especially in cases with penetrating trauma, purulent drainage, or evidence of MRSA infection elsewhere 1.
• Elevation of the affected foot above heart level to reduce swelling and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are also recommended 1.
• Patients should monitor for signs of worsening infection, such as spreading redness, increasing pain, fever, or streaking from the infection site, which may indicate the need for immediate medical attention.

Additional Recommendations

• Outpatient therapy is recommended for patients who do not have systemic signs of infection, altered mental status, or hemodynamic instability, while hospitalization is recommended for severe cases or those with concerns for deeper or necrotizing infections 1.
• Proper wound care is essential if there's an entry point for infection, and patients should apply warm compresses to improve circulation and take over-the-counter pain relievers like acetaminophen or ibuprofen as needed.
• The interdigital toe spaces should be carefully examined and treated if necessary, as fissuring, scaling, or maceration in these areas can eradicate colonization with pathogens and reduce the incidence of recurrent infection 1.

From the Research

Treatment for Foot Cellulitis

The treatment for foot cellulitis typically involves antibiotic therapy. According to 2, macrolides/streptogramins were found to be more effective than penicillin antibiotics in treating cellulitis.

• The study found that oral therapies can be more effective than intravenous therapies in some cases 2.
• Another study found that trimethoprim-sulfamethoxazole and clindamycin are preferred empiric therapies for outpatients with cellulitis in areas with a high prevalence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections 3.
• The duration of antibiotic therapy can vary depending on several factors, including patient age, C-reactive protein levels, presence of diabetes mellitus, and presence of blood stream infection 4.
• A study found that there is no association between the route of antibiotic administration (intravenous or oral) and clinical outcome, and that a course length of more than 5 days may not result in any additional benefit 5.

Prevention of Recurrent Cellulitis

In addition to treating the current infection, preventing recurrent cellulitis is also important.

• A study found that people who have had cellulitis are keen to know about possible ways to prevent further episodes, and that enhanced foot hygiene, applying emollients daily, exercise, and losing weight are generally viewed as more acceptable and feasible strategies than compression or antibiotics 6.

Antibiotic Therapy

Antibiotic therapy is a crucial part of treating foot cellulitis.

• The choice of antibiotic and duration of therapy should be based on the severity of the infection and the presence of any underlying conditions, such as diabetes mellitus or blood stream infection 2, 4.
• The use of long-term, low-dose antibiotics may be necessary to reduce the risk of recurrence in some cases 6.