From the Guidelines
The most common IV antibiotics for treating cellulitis are vancomycin, cefazolin, and linezolid, with vancomycin being a preferred option for suspected MRSA infections, as recommended by the Infectious Diseases Society of America 1. When treating cellulitis, it's essential to consider the severity of the infection, the presence of systemic signs, and the potential for MRSA.
- For patients with severe infections or those who are hospitalized, IV vancomycin is often the first-line choice, dosed at 15-20mg/kg IV every 12 hours 1.
- Cefazolin is another option, typically dosed at 1-2g IV every 8 hours, and is effective against methicillin-sensitive Staphylococcus aureus (MSSA) and streptococci 1.
- Linezolid, dosed at 600mg IV every 12 hours, is also a viable option, especially for patients with suspected MRSA infections 1. Key considerations when administering these medications include monitoring renal function, especially with vancomycin, and assessing for clinical improvement within 48-72 hours 1. If no improvement occurs, broadening coverage or investigating for deeper infection may be necessary. These antibiotics target the bacterial cell wall or protein synthesis, effectively eliminating the infection while the body's immune system helps clear the remaining bacteria. Treatment duration typically ranges from 5-14 days, depending on clinical response, with many patients transitioning to oral antibiotics once improvement is seen 1.
From the Research
Most Common IV Antibiotics for Treating Cellulitis
- Cefazolin is a commonly used IV antibiotic for treating cellulitis, as seen in studies 2, 3, 4, 5
- Ceftriaxone is another IV antibiotic used to treat cellulitis, as compared to cefazolin in study 2
- Ampicillin/sulbactam is also used to treat skin and skin-structure infections, including cellulitis, as seen in study 6
- Cefoxitin is used to treat other skin and skin-structure infections, as seen in study 6
Treatment Regimens
- Once-daily IV cefazolin plus oral probenecid is a effective treatment option for moderate-to-severe cellulitis, as seen in study 2
- Twice-daily cefazolin 2 g IV is a convenient and effective option for home-based treatment of patients with cellulitis, as seen in study 4
- The duration of antibiotic therapy for cellulitis can be affected by factors such as patient age, C-reactive protein levels, presence of diabetes mellitus, and presence of blood stream infection, as seen in study 5
Efficacy and Safety
- Cefazolin has been shown to be effective in treating cellulitis, with clinical cure rates of 86% to 96%, as seen in studies 2, 4
- Ceftriaxone has also been shown to be effective in treating cellulitis, with clinical cure rates of 96%, as seen in study 2
- Ampicillin/sulbactam and cefoxitin have been shown to be effective in treating skin and skin-structure infections, including cellulitis, as seen in study 6