From the Guidelines
The recommended treatment for cellulitis of the lower limb typically involves empiric antibiotic therapy targeting common causative organisms, primarily beta-hemolytic streptococci and Staphylococcus aureus. For mild to moderate uncomplicated cellulitis, oral antibiotics such as cephalexin (500 mg four times daily), dicloxacillin (500 mg four times daily), or clindamycin (300-450 mg three times daily) for 5 days are usually effective, as a 5-day course of antimicrobial therapy is as effective as a 10-day course if clinical improvement has occurred by 5 days 1. In cases of suspected MRSA, options include trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily), doxycycline (100 mg twice daily), or linezolid (600 mg twice daily) 1. For severe infections or in patients with systemic symptoms, hospitalization for intravenous antibiotics like cefazolin (1-2 g every 8 hours), vancomycin (15-20 mg/kg every 12 hours), or clindamycin (600-900 mg every 8 hours) may be necessary 1. Supportive measures are also important, including elevation of the affected limb to reduce edema, adequate pain management, and proper wound care if applicable. Patients should be advised to rest, keep the affected area clean and dry, and monitor for signs of worsening infection such as increasing redness, warmth, pain, or fever. Treatment effectiveness should be assessed within 48-72 hours, and antibiotics may need adjustment if there's inadequate response. These antibiotics work by disrupting bacterial cell wall synthesis or protein production, effectively eliminating the infection while the body's immune system assists in the healing process. It is also recommended to treat predisposing factors, such as edema or underlying cutaneous disorders, and to carefully examine the interdigital toe spaces for fissuring, scaling, or maceration, as treating these conditions may eradicate colonization with pathogens and reduce the incidence of recurrent infection 1.
From the Research
Treatment of Cellulitis of the Lower Limb
The treatment of cellulitis of the lower limb typically involves the use of antibiotics. According to a study published in 2016 2, the most commonly prescribed antibiotics for cellulitis were cloxacillin and other penicillins, followed by cephalosporins.
Antibiotic Regimens
- A study published in 2017 3 compared the use of flucloxacillin with or without clindamycin for the treatment of limb cellulitis and found no significant difference in improvement at day 5.
- Another study published in 2017 4 compared the use of ibuprofen with placebo in adults with uncomplicated cellulitis of the upper or lower limb and found no significant benefit of adjunctive ibuprofen.
- A study published in 2004 5 compared a short-course (5 days) and standard (10 days) treatment for uncomplicated cellulitis and found that 5 days of therapy was as effective as 10 days of therapy.
Broad-Spectrum vs Narrow-Spectrum Antibiotics
- A study published in 2018 6 compared the use of broad-spectrum antibiotics and narrow-spectrum antibiotics in the treatment of lower extremity cellulitis and found that repeat visit due to cellulitis was similar in both groups.
- The study suggested that broad-spectrum antibiotic use in uncomplicated cellulitis was common and unjustified, and recommended the implementation of clinical practice guidelines to limit broad-spectrum antibiotics use.
Key Findings
- The use of antibiotics such as cloxacillin, penicillins, and cephalosporins is common in the treatment of cellulitis of the lower limb 2.
- The addition of clindamycin to flucloxacillin does not improve outcome, but may increase the risk of diarrhea 3.
- Ibuprofen does not appear to have a significant benefit in the treatment of uncomplicated cellulitis 4.
- A short-course of antibiotic therapy (5 days) may be as effective as a standard course (10 days) for uncomplicated cellulitis 5.
- The use of broad-spectrum antibiotics may not be justified in uncomplicated cellulitis, and narrow-spectrum antibiotics may be a suitable alternative 6.