From the Guidelines
Cellulitis treatment should involve a 5- to 6-day course of antibiotics active against streptococci, such as cephalexin, penicillin, or clindamycin, for patients with nonpurulent cellulitis who are able to self-monitor and have close follow-up with primary care. This approach is supported by the most recent guidelines, including the 2021 best practice advice from the American College of Physicians 1. The choice of antibiotic should be based on the severity of the infection and the patient's ability to tolerate oral medications. 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) are suitable options.
In addition to antibiotics, patients should be advised to:
- Elevate the affected area to reduce swelling
- Apply warm compresses to promote blood flow and reduce pain
- Take over-the-counter pain relievers like acetaminophen or ibuprofen as needed
- Mark the border of the redness with a pen to monitor if the infection is spreading
- Seek immediate medical attention if fever persists beyond 48 hours of antibiotic treatment, the redness expands beyond the marked border, or pain worsens.
It's essential to note that a shorter course of antibiotics, such as 5-6 days, can be effective for patients with uncomplicated cellulitis, as shown in a study published in 2021 1. However, the treatment duration may need to be adjusted based on the patient's response to therapy and the severity of the infection. The 2014 IDSA guideline also recommends that patients should receive antibiotics for uncomplicated cellulitis, and a study published in the same year found that a 5-day course of antimicrobial therapy is as effective as a 10-day course, if clinical improvement has occurred by 5 days 1.
From the FDA Drug Label
The cure rates in clinically evaluable patients with complicated skin and skin structure infections were 90% in linezolid-treated patients and 85% in oxacillin-treated patients The cure rates by pathogen for microbiologically evaluable patients are presented in Table 18. The treatment for cellulitis, which is a type of skin and skin structure infection, is linezolid (ZYVOX), with a recommended dosage of 600 mg IV or oral every 12 hours for 10 to 14 days 2.
- Key points:
- Linezolid is effective against various pathogens, including Staphylococcus aureus and Streptococcus pyogenes.
- The cure rates for linezolid-treated patients with complicated skin and skin structure infections were 90%.
- The recommended duration of treatment is 10 to 14 days.
From the Research
Treatment for Cellulitis
The treatment for cellulitis typically involves antibiotics, and the choice of antibiotic may depend on the severity of the infection and the presence of methicillin-resistant Staphylococcus aureus (MRSA) [ 3, 4, 5 ].
- For uncomplicated cellulitis, a short course (5 days) of levofloxacin may be as effective as a standard course (10 days) [ 3 ].
- In cases of MRSA preseptal cellulitis, combination therapy with linezolid and rifampin may be an alternative option [ 4 ].
- For outpatients with cellulitis, empiric therapy with trimethoprim-sulfamethoxazole or clindamycin may be preferred due to their activity against community-associated MRSA [ 5 ].
Combination Therapy
Some studies suggest that combination antibiotic and anti-inflammatory therapy may hasten the resolution of cellulitis [ 6 ].
- The addition of an oral anti-inflammatory agent, such as ibuprofen, to antibiotic treatment may shorten the time to regression of inflammation and complete resolution of cellulitis [ 6 ].
Antimicrobial Activity
The rise of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has complicated the empirical antimicrobial treatment of cellulitis [ 7 ].
- However, published clinical practice guidelines suggest that CA-MRSA plays only a minor role in nonpurulent cellulitis, and initial treatment should be primarily directed at β-hemolytic streptococci [ 7 ].