From the Guidelines
For facial cellulitis, the recommended first-line antibiotic regimen is oral clindamycin 300-450 mg four times daily for 5-10 days, as it provides coverage for both Streptococcus and Staphylococcus species, including MRSA 1. This recommendation is based on the most recent guidelines from the Infectious Diseases Society of America, which emphasize the importance of covering MRSA in patients with severe or extensive disease, including those with facial 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. In patients with mild nonpurulent cellulitis, an antimicrobial agent active against streptococci, such as cephalexin or amoxicillin-clavulanate, may be sufficient 1. However, in patients with more severe infection or those who are at high risk for MRSA, such as those with nasal colonization or a history of MRSA infection, vancomycin or another antimicrobial effective against both MRSA and streptococci is recommended 1. It is essential to note that the duration of antimicrobial therapy should be individualized based on the patient's clinical response, and treatment should be extended if the infection has not improved within 5 days 1. Additionally, supportive measures such as elevation of the affected area, warm compresses, and pain management with acetaminophen or ibuprofen are crucial in the management of facial cellulitis 1. In severe cases requiring hospitalization, intravenous antibiotics such as cefazolin or ampicillin-sulbactam may be necessary, and the patient's clinical response should be closely monitored to adjust treatment as needed 1.
From the Research
Antibiotic Regimen for Facial Cellulitis
The recommended antibiotic regimen for facial cellulitis depends on the causative organism and the severity of the infection.
- For methicillin-susceptible Staphylococcus aureus (MSSA) infections, penicillinase-resistant penicillins (flucloxacillin, dicloxacillin) are the antibiotics of choice 2.
- First-generation cephalosporins (cefazolin, cephalothin, and cephalexin) can also be used for less serious MSSA infections, but are contraindicated in patients with immediate penicillin hypersensitivity 2.
- For methicillin-resistant Staphylococcus aureus (MRSA) infections, vancomycin or teicoplanin can be used for serious infections, while lincosamides (clindamycin, lincomycin) or cotrimoxazole can be used for less serious infections 2, 3.
- Ceftriaxone has been shown to be effective in the treatment of skin and soft tissue infections, including those caused by staphylococci and streptococci 4, 5.
- A once-daily regimen of cefazolin plus oral probenecid has been shown to be equivalent to a once-daily regimen of ceftriaxone plus oral placebo for the treatment of moderate-to-severe cellulitis in adults 6.
Treatment Options
- Ceftriaxone can be given every 12 hours in children and every 24 hours in most adults, making it a convenient option for outpatient treatment 4.
- Linezolid and rifampin combination therapy may provide an alternative therapeutic option for cutaneous MRSA infections that respond poorly to vancomycin 3.
- Cefazolin-probenecid is a cheap, practical, and effective treatment option for moderate-to-severe cellulitis, and it avoids the need to use third-generation cephalosporins in most patients 6.