What is the recommended management and duration of treatment for cellulitis?

From the Guidelines

The recommended management for cellulitis typically involves empiric antibiotic therapy targeting Streptococcus and Staphylococcus species, with a standard duration of treatment of 5-6 days, as recommended by the American College of Physicians 1.

Key Considerations

• For mild, uncomplicated cellulitis, oral antibiotics such as cephalexin, dicloxacillin, or clindamycin are appropriate, as stated in the 2014 IDSA guideline 1.
• The choice of antibiotic should be active against streptococci, and consideration should be given to the patient's ability to self-monitor and have close follow-up with primary care, as noted in the 2021 American College of Physicians guideline 1.
• In cases of severe cellulitis or those with comorbidities, the duration of treatment may need to be extended, and hospitalization may be required, as suggested by the 2014 IDSA guideline 1.
• Elevation of the affected limb, proper wound care, and pain management are important supportive measures, as recommended by the 2014 IDSA guideline 1.
• If MRSA is suspected or confirmed, appropriate coverage with trimethoprim-sulfamethoxazole, doxycycline, or linezolid should be used, as noted in the 2014 IDSA guideline 1.

Duration of Treatment

• A 5- to 6-day course of antibiotics is recommended for nonpurulent cellulitis, as stated in the 2021 American College of Physicians guideline 1.
• The duration of treatment may need to be extended in cases of severe cellulitis or those with comorbidities, as suggested by the 2014 IDSA guideline 1.

Antibiotic Choices

• Cephalexin, dicloxacillin, and clindamycin are suitable options for oral antibiotics, as stated in the 2014 IDSA guideline 1.
• Vancomycin, daptomycin, linezolid, or telavancin may be used for intravenous therapy in severe cases, as noted in the 2014 IDSA guideline 1.

From the FDA Drug Label

In controlled clinical trials, the protocol-defined duration of treatment for all infections ranged from 7 to 28 days. Total treatment duration was determined by the treating physician based on site and severity of the infection, and on the patient's clinical response. The recommended dosage for ZYVOX formulations for the treatment of infections is described in Table 14. Complicated skin and skin structure infections: 10 to 14 days Uncomplicated skin and skin structure infections: 10 to 14 days

The management and duration of treatment for cellulitis is as follows:

• Duration of treatment: 10 to 14 days for uncomplicated skin and skin structure infections, and 10 to 14 days for complicated skin and skin structure infections.
• Management: The treatment duration is determined by the treating physician based on the site and severity of the infection, and on the patient's clinical response 2.

In another study, tedizolid was compared to linezolid for the treatment of acute bacterial skin and skin structure infections, including cellulitis/erysipelas, and the treatment duration for tedizolid was 6 days, while for linezolid it was 10 days 3.

From the Research

Management of Cellulitis

• The management of cellulitis typically involves the use of antibiotics, with the choice of antibiotic depending on the severity of the infection and the suspected causative organism 4, 5.
• For mild to moderate cellulitis, oral antibiotics such as cephalexin, trimethoprim-sulfamethoxazole, or clindamycin may be used 5, 6.
• For more severe infections, intravenous antibiotics may be necessary, and the choice of antibiotic may depend on the results of culture and sensitivity testing 7, 4.

Duration of Treatment

• The duration of treatment for cellulitis typically ranges from 7 to 14 days, depending on the severity of the infection and the response to treatment 8, 4.
• A study published in the Archives of Internal Medicine found that the median duration of antibiotic therapy for cellulitis was 10 days, with a range of 9 to 12 days 8.
• Another study published in the American Journal of Medicine found that the treatment success rate for trimethoprim-sulfamethoxazole was higher than that of cephalexin, and that clindamycin was more effective than cephalexin in patients with moderately severe cellulitis or those who were obese 5.

Factors Affecting Treatment

• The presence of methicillin-resistant Staphylococcus aureus (MRSA) can affect the choice of antibiotic and the duration of treatment 5, 6.
• A study published in the Annals of Pharmacotherapy found that cephalexin was the most cost-effective option for outpatient empiric therapy of cellulitis, but that clindamycin became more cost-effective at higher probabilities of MRSA infection 6.
• Other factors that can affect treatment include the severity of the infection, the presence of underlying medical conditions, and the patient's response to treatment 8, 4.