From the Guidelines
For uncomplicated cellulitis, empirical therapy for infection due to b-hemolytic streptococci is recommended, with options including cephalexin or dicloxacillin, while for purulent cellulitis, empirical therapy for CA-MRSA is recommended, with options including clindamycin, TMP-SMX, or a tetracycline 1. When considering the treatment of cellulitis, it's crucial to differentiate between purulent and nonpurulent cases, as this distinction guides the choice of antibiotic therapy.
- For nonpurulent cellulitis, cephalexin (500 mg orally four times daily for 5-10 days) is a reasonable first-line option, targeting beta-hemolytic streptococci, a common cause of this condition 1.
- For purulent cellulitis, where CA-MRSA is suspected, clindamycin (300-450 mg orally three times daily) or TMP-SMX (1-2 double-strength tablets twice daily) are recommended, as they provide coverage against CA-MRSA 1.
- In cases where there's a suspicion or confirmation of MRSA, or in patients not responding to initial therapy, consideration of antibiotics with MRSA coverage, such as clindamycin or TMP-SMX, is essential 1.
- The duration of therapy should be individualized based on the patient's clinical response but typically ranges from 5 to 10 days for uncomplicated cases 1.
- It's also important to note that for hospitalized patients with complicated SSTI, including severe cellulitis, intravenous antibiotics such as vancomycin, linezolid, or daptomycin may be necessary, with the choice depending on the severity of the infection, patient comorbidities, and local resistance patterns 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Antibiotic Treatment for Cellulitis
The choice of antibiotic for treating cellulitis depends on various factors, including the severity of the infection, the presence of methicillin-resistant Staphylococcus aureus (MRSA), and patient-specific factors such as allergies and comorbidities.
- First-line treatment options:
- Trimethoprim-sulfamethoxazole, cephalexin, or clindamycin are commonly prescribed antibiotics for cellulitis, as shown in a study published in 2010 2.
- Cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis was compared in a randomized controlled trial in 2013, which found no significant difference in treatment success between the two groups 3.
- Alternative treatment options:
- Flucloxacillin monotherapy versus flucloxacillin/phenoxymethylpenicillin dual therapy for the outpatient treatment of cellulitis is being investigated in the PEDOCELL trial, with results pending 4.
- A short course (5 days) of levofloxacin was found to be as effective as a standard course (10 days) for uncomplicated cellulitis in a randomized, double-blind, placebo-controlled trial published in 2004 5.
- Adjunctive therapy:
- The addition of oral nonsteroidal anti-inflammatory (NSAI) therapy to antibiotic treatment may hasten the resolution of cellulitis-related inflammation, as suggested by a pilot study published in 2005 6.