What are the latest management strategies for cellulitis?

From the Guidelines

Cellulitis management should primarily involve a 5- to 6-day course of antibiotics active against streptococci, particularly for patients able to self-monitor and who have close follow-up with primary care 1.

Key Considerations

• The choice of antibiotic should be guided by local resistance patterns, patient risk factors for resistant organisms, and severity of infection.
• For mild cellulitis in patients without systemic symptoms, oral antibiotics are recommended, with options including cephalexin, dicloxacillin, clindamycin, or trimethoprim-sulfamethoxazole (TMP-SMX) 1.
• For moderate to severe cellulitis with systemic symptoms, intravenous antibiotics are necessary, such as cefazolin, vancomycin, or clindamycin 1.

Supportive Measures

• Elevation of the affected limb to reduce edema and promote gravity drainage of inflammatory substances is recommended 1.
• Patients should also receive therapy for any predisposing conditions, such as tinea pedis, trauma, or venous eczema (“stasis dermatitis”) 1.
• Pain management and proper wound care if applicable should also be considered.

Monitoring and Adjustment

• Patients should be monitored for response within 48-72 hours, with consideration for antibiotic adjustment if improvement is not observed 1.
• The duration of antimicrobial therapy should be 5 days, but treatment should be extended if the infection has not improved within this time period 1.

From the FDA Drug Label

14 CLINICAL STUDIES 14. 1 Acute Bacterial Skin and Skin Structure Infections

Adults A total of 1333 adults with acute bacterial skin and skin structure infections (ABSSSI) were randomized in two multicenter, multinational, double-blind, non-inferiority trials. Both trials compared SIVEXTRO 200 mg once daily for 6 days versus linezolid 600 mg every 12 hours for 10 days In Trial 1, patients were treated with oral therapy, while in Trial 2, patients could receive oral therapy after a minimum of one day of intravenous therapy. Patients with cellulitis/erysipelas, major cutaneous abscess, or wound infection were enrolled in the trials Patients with wound infections could have received aztreonam and/or metronidazole as adjunctive therapy for gram-negative bacterial coverage, if needed.

The latest management strategies for cellulitis include:

• Oral therapy with SIVEXTRO 200 mg once daily for 6 days
• Oral therapy with linezolid 600 mg every 12 hours for 10 days
• Adjunctive therapy with aztreonam and/or metronidazole for gram-negative bacterial coverage, if needed, in patients with wound infections 2

From the Research

Management Strategies for Cellulitis

The management of cellulitis involves various strategies, including:

• Antibiotic therapy: The use of antibiotics such as levofloxacin 3, trimethoprim-sulfamethoxazole 4, cephalexin 4, 5, 6, and clindamycin 4 has been studied in the treatment of cellulitis.
• Duration of antibiotic therapy: A study found that 5 days of levofloxacin therapy was as effective as 10 days of therapy for uncomplicated cellulitis 3.
• Dose of antibiotic therapy: A pilot randomized controlled trial found that high-dose cephalexin (1000 mg) had fewer treatment failures but more minor adverse effects compared to standard-dose cephalexin (500 mg) 5.
• Combination therapy: The addition of an oral nonsteroidal anti-inflammatory agent to antibiotic treatment has been shown to hasten the resolution of cellulitis-related inflammation 7.

Antibiotic Selection

The selection of antibiotics for the treatment of cellulitis depends on various factors, including:

• The causative pathogen: β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus are common causes of non-purulent, uncomplicated cellulitis 6.
• The presence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA): Antibiotics with activity against MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, may be preferred in areas with a high prevalence of MRSA 4.
• Patient factors: Such as severity of cellulitis, presence of comorbidities, and allergy history.

Treatment Outcomes

The outcomes of cellulitis treatment can be influenced by various factors, including:

• Antibiotic choice: The use of antibiotics with activity against the causative pathogen can improve treatment outcomes 4, 6.
• Duration and dose of antibiotic therapy: The optimal duration and dose of antibiotic therapy for cellulitis are still being studied 3, 5.
• Combination therapy: The addition of an anti-inflammatory agent to antibiotic treatment may improve treatment outcomes 7.