From the Guidelines
The recommended treatment for inpatient cellulitis of the lower legs typically involves intravenous antibiotics, with consideration of empirical therapy for MRSA pending culture data, and options include IV vancomycin, linezolid, daptomycin, telavancin, or clindamycin. When choosing an antibiotic, it's crucial to consider the severity of the disease, patient comorbidities, and potential resistance patterns, as outlined in the guidelines by the Infectious Diseases Society of America 1. For hospitalized patients with complicated skin and soft-tissue infections (SSTI), including cellulitis, broad-spectrum antibiotics covering MRSA are often necessary.
- Key considerations in the management of inpatient cellulitis include:
- The use of broad-spectrum antibiotics that cover both Streptococcus and Staphylococcus species, including MRSA
- Surgical debridement for cases with significant necrotic tissue or abscesses
- Supportive care such as elevation of the affected limb, pain management, and wound care
- Monitoring for clinical improvement and adjustment of antibiotic therapy based on culture results and clinical response
- The choice of antibiotic should be guided by local resistance patterns and patient-specific factors such as renal function and allergy history, with options including IV vancomycin (A-I), linezolid 600 mg PO/IV twice daily (A-I), daptomycin 4 mg/kg/dose IV once daily (A-I), telavancin 10 mg/kg/dose IV once daily (A-I), or clindamycin 600 mg IV/PO three times a day (A-III) as recommended by 1.
- Treatment duration is generally 7-14 days but should be individualized based on the patient’s clinical response, as indicated in the guidelines 1.
From the Research
Treatment Options for Inpatient Cellulitis of the Lower Legs
- The treatment for inpatient cellulitis of the lower legs typically involves the use of antibiotics, with the choice of antibiotic depending on the suspected or confirmed causative pathogen 2, 3, 4, 5, 6.
- Cefazolin, a first-generation cephalosporin, has been shown to be effective in treating lower limb infections, including cellulitis, with adequate tissue penetration 2.
- Benzathine penicillin G has been used as prophylaxis to prevent recurrences of cellulitis, particularly in patients without predisposing factors 3.
- In cases of multidrug-resistant pathogens, such as Streptococcus pseudoporcinus, alternative antibiotics like cefepime and vancomycin may be necessary 4.
- Economic evaluations have compared the costs of different antibiotic treatments, including linezolid, flucloxacillin, and vancomycin, for the empirical treatment of cellulitis in hospitalized patients 5.
- Once-daily regimens of cefazolin plus probenecid and ceftriaxone plus placebo have been shown to be equivalent in treating moderate-to-severe cellulitis in adults 6.
Antibiotic Choices
- Cefazolin: effective against methicillin-susceptible Staphylococcus aureus and streptococci, with adequate tissue penetration 2.
- Benzathine penicillin G: used as prophylaxis to prevent recurrences of cellulitis, particularly in patients without predisposing factors 3.
- Cefepime and vancomycin: alternative antibiotics for multidrug-resistant pathogens, such as Streptococcus pseudoporcinus 4.
- Linezolid: effective against both antibiotic-susceptible and antibiotic-resistant Gram-positive bacterial infections, including those resistant to other available antibiotics 5.
- Ceftriaxone: a third-generation cephalosporin, which can be used as an alternative to cefazolin 6.