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 considering the severity of the infection and the presence of any underlying conditions that may affect the patient's response to treatment.

• For mild cases, oral antibiotics such as cephalexin, dicloxacillin, or amoxicillin-clavulanate are usually effective for 5-10 days 1.
• More severe cases may require intravenous antibiotics such as ceftriaxone or vancomycin in a hospital setting 1. While taking antibiotics, it's essential to elevate the affected area, rest, and apply warm compresses to reduce swelling and pain.
• Over-the-counter pain relievers like acetaminophen or ibuprofen can help manage discomfort.
• Complete the full course of antibiotics even if symptoms improve early to prevent recurrence or antibiotic resistance. It's crucial to seek immediate medical attention if you develop fever, increasing pain, red streaking from the infection site, or if the affected area continues to expand despite treatment. Cellulitis requires prompt treatment because the infection can spread rapidly through tissue and potentially enter the bloodstream if left untreated. In addition to antibiotics, elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended 1. For patients with severe or recurrent cellulitis, prophylactic antibiotics or alternative treatments such as oral selenium may be considered 1. However, the most recent and highest quality study 1 provides the most up-to-date guidance on the treatment of cellulitis, emphasizing the importance of antimicrobial therapy and supportive care.

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.

• 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. 2

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.
• A study comparing short-course (5 days) and standard (10 days) treatment for uncomplicated cellulitis found that 5 days of therapy with levofloxacin was as effective as 10 days of therapy 4.
• The addition of an oral anti-inflammatory agent to antibiotic treatment has been shown to hasten the resolution of cellulitis-related inflammation 5.

Antibiotic Administration Routes

The route of antibiotic administration for cellulitis can vary, with both oral and intravenous options available.

• A systematic review and meta-analysis is currently underway to compare the efficacy of oral versus intravenous antibiotic administration for cellulitis infections 6.
• Some studies suggest that oral antibiotics can be effective in treating cellulitis, especially in cases where the infection is uncomplicated 4.
• Intravenous antibiotics may be necessary in more severe cases of cellulitis, or in cases where oral antibiotics are not effective 6.

Special Considerations

In some cases, special considerations may be necessary when treating cellulitis.

• Patients with recurrent severe cellulitis may benefit from a "pill in pocket" approach, where they are prescribed a course of oral antibiotics to take as needed 7.
• Patients with chronic lymphoedema may be at increased risk for recurrent cellulitis, and may require long-term antibiotic therapy to prevent recurrences 7.