From the Guidelines
The first-line treatment for cellulitis is a 5- to 6-day course of antibiotics active against streptococci, such as cephalexin or dicloxacillin, for patients able to self-monitor and who have close follow-up with primary care. This recommendation is based on the most recent and highest quality study available, which suggests that a shorter course of antibiotics can be effective in treating nonpurulent cellulitis 1. The choice of antibiotic should be guided by the severity of the infection, the presence of systemic signs of infection, and the patient's underlying health status. For patients with penicillin allergies, clindamycin or trimethoprim-sulfamethoxazole are appropriate alternatives. It is essential to note that the treatment should begin promptly after diagnosis to prevent the spread of infection. In addition to antibiotics, patients should elevate the affected limb when possible, keep the area clean and dry, and monitor for signs of worsening infection such as increasing redness, warmth, pain, or fever. If symptoms worsen despite 48-72 hours of oral antibiotics, or if the patient has signs of systemic illness, severe infection, or immunocompromise, hospitalization for intravenous antibiotics may be necessary.
Some key points to consider when treating cellulitis include:
- The use of antibiotics active against streptococci, such as cephalexin or dicloxacillin, as the first-line treatment 1
- The consideration of a 5- to 6-day course of antibiotics for nonpurulent cellulitis 1
- The importance of elevating the affected limb, keeping the area clean and dry, and monitoring for signs of worsening infection
- The potential need for hospitalization for intravenous antibiotics if symptoms worsen or if the patient has signs of systemic illness, severe infection, or immunocompromise
- The consideration of alternative antibiotics, such as clindamycin or trimethoprim-sulfamethoxazole, for patients with penicillin allergies 1
It is crucial to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions, and to base these decisions on the most recent and highest quality evidence available 1.
From the Research
First-Line Treatment for Cellulitis
The first-line treatment for cellulitis typically involves the use of antibiotics. Several studies have investigated the effectiveness of different antibiotic regimens for the treatment of cellulitis.
- Antibiotic Options:
- Levofloxacin: A study published in 2004 2 found that 5 days of therapy with levofloxacin was as effective as 10 days of therapy for patients with uncomplicated cellulitis.
- Linezolid: A decision analytical model published in 2001 3 predicted that initiating empirical treatment of cellulitis with linezolid would result in higher overall success rates and be less costly than flucloxacillin and vancomycin in certain scenarios.
- Trimethoprim-sulfamethoxazole, cephalexin, and clindamycin: A retrospective cohort study published in 2010 4 found that trimethoprim-sulfamethoxazole had a higher treatment success rate than cephalexin, while clindamycin had higher success rates in patients with MRSA infections, moderately severe cellulitis, and obesity.
- Cephalexin plus trimethoprim-sulfamethoxazole: A randomized controlled trial published in 2013 5 found that the addition of trimethoprim-sulfamethoxazole to cephalexin did not improve outcomes for patients with uncomplicated cellulitis.
Combination Therapy
Some studies have also investigated the use of combination therapy, including antibiotics and anti-inflammatory agents, for the treatment of cellulitis.
- Anti-Inflammatory Therapy: A pilot study published in 2005 6 found that the addition of an oral anti-inflammatory agent (ibuprofen) to antibiotic therapy significantly shortened the time to regression of inflammation and complete resolution of cellulitis.