What is the treatment for cellulitis?

From the Guidelines

Cellulitis is typically treated with antibiotics, with the specific regimen depending on severity, and the recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period 1. The treatment approach for cellulitis involves selecting an antibiotic active against streptococci, as these bacteria are the most common cause of the infection. For mild cases, oral antibiotics such as cephalexin, dicloxacillin, or amoxicillin-clavulanate are suitable options 1. In more severe cases, or when there are signs of systemic infection, intravenous antibiotics like ceftriaxone or vancomycin may be necessary, especially if there's a concern for methicillin-resistant Staphylococcus aureus (MRSA) infection 1. Some key considerations in managing cellulitis include:

• Elevation of the affected area to reduce swelling and promote drainage
• Rest and application of warm compresses to improve circulation
• Completing the full course of antibiotics to prevent recurrence or antibiotic resistance
• Proper wound care, including keeping the area clean and covered with sterile dressings if there's a break in the skin
• Addressing underlying conditions that may have predisposed to the infection, such as tinea pedis or venous eczema It's also important to note that each episode of cellulitis can cause lymphatic inflammation and potential permanent damage, and severe or repeated episodes may lead to lymphedema. Measures to reduce recurrences include treating interdigital maceration, keeping the skin hydrated, and reducing underlying edema 1. In cases of recurrent cellulitis, prophylactic antibiotics or providing oral antibiotics for the patient to initiate therapy at the onset of symptoms may be considered, although the efficacy of these approaches can vary 1.

From the FDA Drug Label

The cure rates in clinically evaluable patients with complicated skin and skin structure infections were 90% in linezolid-treated patients and 85% in oxacillin-treated patients The cure rates by pathogen for microbiologically evaluable patients are presented in Table 18. The treatment for cellulitis, which is a type of skin and skin structure infection, is linezolid (ZYVOX), with a recommended dosage of 600 mg IV or oral every 12 hours for 10 to 14 days 2.

• Key points:
  • Linezolid is effective against MRSA and other Gram-positive pathogens.
  • The cure rates for linezolid-treated patients with complicated skin and skin structure infections were 90%.
  • The recommended duration of treatment is 10 to 14 days.

From the Research

Treatment Options for Cellulitis

The treatment for cellulitis typically involves the use of antibiotics, with the choice of antibiotic depending on the severity of the infection and the presence of certain risk factors.

• Antibiotics such as trimethoprim-sulfamethoxazole, cephalexin, and clindamycin are commonly used to treat cellulitis 3.
• The use of antibiotics with activity against community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), such as trimethoprim-sulfamethoxazole and clindamycin, is preferred in areas with a high prevalence of CA-MRSA infections 3.
• However, some studies suggest that CA-MRSA may play a minor role in nonpurulent cellulitis, and that initial treatment should be primarily directed at β-hemolytic streptococci 4.

Duration of Treatment

The duration of treatment for cellulitis can vary, but some studies suggest that a short course of antibiotics (5 days) may be as effective as a standard course (10 days) in patients with uncomplicated cellulitis 5.

• A study comparing 5 days of levofloxacin therapy with 10 days of therapy found no significant difference in clinical outcome between the two groups 5.
• Another study found that the addition of an oral anti-inflammatory agent to antibiotic treatment can hasten the resolution of cellulitis-related inflammation 6.

Route of Antibiotic Administration

The route of antibiotic administration (oral vs. intravenous) can also vary, and some studies are investigating the optimal route of administration for cellulitis treatment 7.

• A systematic review and meta-analysis is currently underway to compare the efficacy of oral versus intravenous antibiotic administration for cellulitis infections 7.
• The review will examine the duration of infection resolution, incidence of sepsis, mortality, hospital admission, and Clostridium difficile infection as primary and secondary outcomes 7.