From the Guidelines
The recommended treatment for cellulitis of an open wound typically involves a combination of antibiotics, wound care, and supportive measures, with first-line antibiotic therapy including oral cephalexin, dicloxacillin, or clindamycin for 5-10 days for mild to moderate infections, as supported by the Infectious Diseases Society of America guidelines 1. The choice of antibiotic should be based on the severity of the infection and the presence of systemic signs of infection. For example, if the patient has a mild infection without systemic signs, oral antibiotics such as cephalexin (500 mg four times daily) or dicloxacillin (500 mg four times daily) may be sufficient 1. However, if the patient has a more severe infection or systemic signs of infection, intravenous antibiotics such as cefazolin (1-2 g every 8 hours) or vancomycin (15-20 mg/kg every 12 hours) may be necessary 1. In addition to antibiotics, proper wound care is essential for promoting healing and preventing further bacterial contamination. This includes cleaning the wound gently with saline solution, covering it with a sterile, non-adherent dressing, and changing the dressing daily or more frequently if drainage is significant 1. Elevation of the affected area can also help reduce swelling and pain. Some key points to consider in the treatment of cellulitis of an open wound include:
- The use of antibiotic dressings has shown no benefit and is not recommended 1
- Topical dressings to control wound exudate and maintain moisture, as well as skin protectants, can be useful adjuncts to wound care 1
- Surgical debridement may be necessary in some cases to promote healing, and non-traditional methods such as ultrasonic and enzymatic debridement can be considered as alternatives 1
- Antimicrobial therapy can be useful in the setting of localized cellulitis or difficult-to-eradicate bacteria, but should be used judiciously and based on clinical judgment 1 Overall, the treatment of cellulitis of an open wound requires a comprehensive approach that includes antibiotics, wound care, and supportive measures, with the goal of promoting healing, preventing further bacterial contamination, and reducing morbidity and mortality.
From the FDA Drug Label
The two trials were similar in design but differed in patient characteristics, including history of diabetes and peripheral vascular disease. There were a total of 534 adult patients treated with daptomycin for injection and 558 treated with comparator in the two trials. The majority (89. 7%) of patients received IV medication exclusively.
Table 15: Investigator’s Primary Diagnosis in the cSSSI Trials in Adult Patients (Population: ITT) Primary Diagnosis Adult Patients (Daptomycin for Injection/ Comparator* ) Study 9801 N=264 / N=266 Study 9901 N=270 / N=292 Pooled N=534 / N=558 Wound Infection 99 (38%) / 116 (44%) 102 (38%) / 108 (37%) 201 (38%) / 224 (40%) Major Abscess 55 (21%) / 43 (16%) 59 (22%) / 65 (22%) 114 (21%) / 108 (19%) Ulcer Infection 71 (27%) / 75 (28%) 53 (20%) / 68 (23%) 124 (23%) / 143 (26%) Other Infection † 39 (15%) / 32 (12%) 56 (21%) / 51 (18%) 95 (18%) / 83 (15%)
The recommended treatment for cellulitis of an open wound is daptomycin for injection at a dose of 4 mg/kg IV q24h or a comparator such as vancomycin (1 g IV q12h) or an anti-staphylococcal semi-synthetic penicillin (i.e., nafcillin, oxacillin, cloxacillin, or flucloxacillin; 4 to 12 g IV per day), as supported by the clinical trials 2.
- Key points:
- Daptomycin for injection was compared to vancomycin or an anti-staphylococcal semi-synthetic penicillin in two randomized trials.
- The majority of patients received IV medication exclusively.
- Clinical success rates were similar between daptomycin for injection and comparator drugs.
- Clinical success rates:
- In study 9801, clinical success rates in the ITT population were 62.5% (165/264) in patients treated with daptomycin for injection and 60.9% (162/266) in patients treated with comparator drugs.
- In study 9901, clinical success rates in the ITT population were 80.4% (217/270) in patients treated with daptomycin for injection and 80.5% (235/292) in patients treated with comparator drugs.
From the Research
Treatment Options for Cellulitis of an Open Wound
The recommended treatment for cellulitis of an open wound involves a combination of antibiotics, wound care, and in some cases, additional therapies such as hyperbaric oxygen. The choice of treatment depends on the severity of the infection, the presence of any underlying conditions, and the patient's overall health.
Antibiotic Therapy
- Antibiotics such as ceftriaxone 3 and ciprofloxacin 4, 5 have been shown to be effective in treating cellulitis.
- The use of oral nonsteroidal anti-inflammatory (NSAI) therapy in combination with antibiotic treatment may hasten the resolution of cellulitis-related inflammation 6.
- The choice of antibiotic should be based on the suspected or confirmed causative organism and its susceptibility to the antibiotic.
Hyperbaric Oxygen Therapy
- Hyperbaric oxygen (HBO) therapy has been shown to be effective in reducing pain, edema, and accelerating wound healing in patients with cellulitis 7.
- HBO therapy may be used in combination with antibiotic therapy and wound care to enhance treatment outcomes.
Wound Care
- Proper wound care, including debridement, drainage, and dressing, is essential for promoting healing and preventing further infection.
- The use of oral antibiotics such as ciprofloxacin may be effective in treating foot infections following nail puncture wounds, provided that surgical intervention is performed first 4.
Treatment Outcomes
- The outcome of treatment for cellulitis of an open wound depends on various factors, including the severity of the infection, the effectiveness of the treatment, and the patient's overall health.
- Studies have shown that combination therapy, including antibiotics, anti-inflammatory agents, and hyperbaric oxygen, may lead to better treatment outcomes, including reduced pain, edema, and accelerated wound healing 7, 6.