From the Research
Follow-up for cellulitis patients should occur within 48-72 hours after initial evaluation to assess treatment response. This early follow-up is crucial to ensure the infection is responding appropriately to antibiotics and not worsening. During this visit, clinicians should evaluate for decreasing erythema (redness), reduced pain, decreased swelling, and resolution of fever. If the patient was started on oral antibiotics like cephalexin (500mg four times daily), clindamycin (300-450mg three times daily), or trimethoprim-sulfamethoxazole (1-2 DS tablets twice daily), they typically require a 5-10 day course depending on severity and response 1. Patients with more severe infections requiring intravenous antibiotics may need daily assessment while hospitalized. If improvement is noted at the first follow-up, subsequent visits can be scheduled at 7-10 days or at completion of the antibiotic course.
Key Considerations
- Early follow-up is important because cellulitis can rapidly progress to more serious conditions like abscess formation, necrotizing fasciitis, or systemic infection if inadequately treated 2.
- Patients should be instructed to return immediately if they develop increased pain, spreading redness, fever, or systemic symptoms regardless of scheduled follow-up.
- The use of telehealth follow-up systems has shown promise in facilitating treatment and discharge of patients with cellulitis, with high rates of engagement and low ED return rates 3.
- Antibiotic prophylaxis has been shown to decrease the risk of cellulitis recurrence by 69% compared to no treatment or placebo, although the protective effects may diminish after prophylaxis is discontinued 4.
Treatment and Follow-up
- Treatment of uncomplicated cellulitis should be directed against Streptococcus and methicillin-sensitive S. aureus 2.
- The addition of an oral anti-inflammatory agent to antibiotic treatment may hasten the resolution of cellulitis-related inflammation 5.
- Patients with recurrent cellulitis may benefit from antibiotic prophylaxis, although the evidence is limited to those with at least two past episodes of leg cellulitis within a time frame of up to three years 4.