From the Guidelines
The recommended treatment for purulent cellulitis is incision and drainage of the purulent collection, followed by antibiotic therapy. For mild cases, oral antibiotics targeting methicillin-resistant Staphylococcus aureus (MRSA) are appropriate, such as trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets twice daily, doxycycline 100 mg twice daily, or clindamycin 300-450 mg four times daily for 5-10 days 1.
Key Considerations
- The choice of antibiotic should be guided by the severity of the infection and the presence of any underlying conditions that may affect the patient's response to treatment.
- For moderate to severe infections, initial intravenous therapy may be necessary with vancomycin 15-20 mg/kg every 12 hours, daptomycin 4-6 mg/kg daily, or linezolid 600 mg twice daily, followed by oral therapy once improvement occurs 1.
- Wound cultures should be obtained before starting antibiotics to guide therapy, especially in patients with severe local infection or signs of systemic illness 1.
- Patients should keep the affected area elevated, apply warm compresses, and monitor for signs of worsening infection such as increasing redness, swelling, pain, or fever.
- The duration of antimicrobial therapy is typically 5 days, but treatment should be extended if the infection has not improved within this time period 1.
Antibiotic Options
- Oral antibiotics:
- Trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets twice daily
- Doxycycline 100 mg twice daily
- Clindamycin 300-450 mg four times daily
- Intravenous antibiotics:
- Vancomycin 15-20 mg/kg every 12 hours
- Daptomycin 4-6 mg/kg daily
- Linezolid 600 mg twice daily It is essential to note that the treatment of purulent cellulitis should be individualized based on the patient's clinical response and the results of wound cultures, if obtained 1.
From the FDA Drug Label
Vancomycin Hydrochloride for Injection, USP is indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (β-lactam-resistant) staphylococci Vancomycin Hydrochloride for Injection, USP has been reported to be effective alone or in combination with an aminoglycoside for endocarditis caused by S. viridans or S. bovis. Vancomycin Hydrochloride for Injection, USP is effective in the treatment of staphylococcal endocarditis, septicemia, bone infections, lower respiratory tract infections, skin and skin structure infections.
The recommended treatment for purulent cellulitis is vancomycin.
- Vancomycin is effective against methicillin-resistant staphylococci and other Gram-positive bacteria that can cause skin and skin structure infections, including purulent cellulitis.
- The treatment should be adjusted according to susceptibility data and local epidemiology. 2
From the Research
Treatment for Purulent Cellulitis
The treatment for purulent cellulitis typically involves the use of antibiotics that target the most common causative organisms, including community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) and Streptococcus species.
- The choice of antibiotic depends on the severity of the infection, the presence of purulence, and the suspected causative organism 3, 4.
- For purulent cellulitis, antibiotics with activity against CA-MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, are preferred empiric therapy 4.
- A study comparing cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for the treatment of uncomplicated cellulitis found that the addition of trimethoprim-sulfamethoxazole to cephalexin did not improve outcomes overall or by subgroup 3.
- Another study found that cefdinir and cephalexin had similar clinical cure rates for mild to moderate uncomplicated skin and skin structure infections, including cellulitis 5.
- A once-daily regimen of cefazolin plus oral probenecid was found to be equivalent to a once-daily regimen of ceftriaxone plus oral placebo for the treatment of moderate-to-severe cellulitis in adults 6.
- A retrospective cohort study found that the use of broad-spectrum antibiotics in uncomplicated cellulitis was common and unjustified, and recommended the implementation of clinical practice guidelines to limit broad-spectrum antibiotics use in such population 7.
Antibiotic Options
Some antibiotic options for the treatment of purulent cellulitis include: