From the Guidelines
The best treatment for cellulitis is antibiotics, typically starting with oral antibiotics for mild to moderate cases, with a recommended duration of 5 days, as indicated by the Infectious Diseases Society of America guidelines 1.
Key Considerations
- First-line treatment usually includes dicloxacillin, cephalexin, or clindamycin for 5-10 days, as these antibiotics are active against streptococci, the most common cause of cellulitis 1.
- For more severe infections or those that don't respond to oral antibiotics, intravenous antibiotics may be necessary, such as cefazolin, nafcillin, or vancomycin if MRSA is suspected 1.
- In addition to antibiotics, elevating the affected area, applying warm compresses, and taking over-the-counter pain relievers like acetaminophen or ibuprofen can help manage symptoms.
- It's essential to complete the full course of antibiotics even if symptoms improve before finishing treatment, as this ensures the infection is fully cleared.
Important Recommendations
- Patients should seek immediate medical attention if they develop fever, increasing pain, rapid spread of redness, or red streaks extending from the infected area, as these may indicate worsening infection 1.
- Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended to promote healing and prevent recurrence 1.
- In cases of uncomplicated cellulitis, a 5-day course of antimicrobial therapy is as effective as a 10-day course, if clinical improvement has occurred by 5 days, as supported by the guidelines 1.
From the FDA Drug Label
- 5 Uncomplicated Skin and Skin Structure Infections Levofloxacin tablets are indicated in adult patients for the treatment of uncomplicated skin and skin structure infections (mild to moderate) including abscesses, cellulitis, furuncles, impetigo, pyoderma, wound infections, due to methicillin-susceptible Staphylococcus aureus, or Streptococcus pyogenes.
The best treatment for cellulitis is levofloxacin tablets for adult patients with uncomplicated skin and skin structure infections (mild to moderate) due to methicillin-susceptible Staphylococcus aureus or Streptococcus pyogenes 2.
- Key points:
- Indicated for uncomplicated skin and skin structure infections
- Includes cellulitis, abscesses, and other infections
- Effective against methicillin-susceptible Staphylococcus aureus or Streptococcus pyogenes
- For adult patients only
- For mild to moderate infections only
From the Research
Treatment Options for Cellulitis
The best treatment for cellulitis typically involves the use of antibiotics, with the specific choice depending on various factors such as the severity of the infection and the presence of methicillin-resistant Staphylococcus aureus (MRSA) [ 3 ].
- Antibiotic Therapy: Studies have shown that antibiotics with activity against community-associated MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, are preferred empiric therapy for outpatients with cellulitis in settings where MRSA is prevalent [ 3 ].
- Combination Therapy: Some research suggests that the addition of an oral nonsteroidal anti-inflammatory (NSAI) therapy to antibiotic treatment may hasten the resolution of cellulitis-related inflammation [ 4 ].
- Route of Administration: There is evidence to suggest that the route of antibiotic administration (intravenous vs oral) may not significantly impact clinical outcome for patients with cellulitis of similar severity [ 5 ].
- Duration of Therapy: The optimal duration of antibiotic therapy for cellulitis is not well established, but some studies indicate that a course length of more than 5 days may not result in additional benefit [ 5 ].
Comparison of Antibiotic Regimens
Comparative studies have evaluated the effectiveness of different antibiotic regimens for the treatment of cellulitis:
- Cephalexin vs Trimethoprim-Sulfamethoxazole: One study found that trimethoprim-sulfamethoxazole had a higher treatment success rate than cephalexin for outpatients with cellulitis [ 3 ].
- Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone: Other studies have shown that the addition of trimethoprim-sulfamethoxazole to cephalexin did not significantly improve outcomes for patients with uncomplicated cellulitis [ 6 , 7 ].