What are the treatment options for cellulitis?

From the Guidelines

Antibiotics are the primary treatment for cellulitis, with a recommended course of 5-7 days, as suggested by the most recent guidelines 1. The choice of antibiotic depends on the severity and suspected bacteria, with options including cephalexin, dicloxacillin, or clindamycin for mild cases, and intravenous antibiotics such as ceftriaxone, vancomycin, or piperacillin-tazobactam for more severe infections. Some key points to consider when treating cellulitis include:

• Targeting Streptococcus and Staphylococcus bacteria, the most common causes of cellulitis
• Considering MRSA coverage with medications like trimethoprim-sulfamethoxazole or doxycycline if suspected
• Elevating the affected area, applying warm compresses, and taking over-the-counter pain relievers to manage symptoms
• Completing the full course of antibiotics even if symptoms improve, and seeking immediate medical attention if fever develops, the affected area expands rapidly, or if there's no improvement after 2-3 days of treatment
• The 2019 National Institute for Health and Care Excellence (NICE) guideline recommends a course of 5 to 7 days 1, which is supported by recent studies, including the DANCE (Duration of Antibiotic Therapy for Cellulitis) RCT 1. It's also important to note that some patients may require additional treatment, such as surgical drainage of an abscess or management of underlying conditions that may have predisposed to the infection. In terms of specific antibiotic regimens, the American College of Physicians recommends a cephalosporin, penicillin, or clindamycin for uncomplicated cellulitis, except for patients with certain risk factors, such as MRSA infection or systemic inflammatory response syndrome 1. Overall, the goal of treatment is to reduce morbidity, mortality, and improve quality of life, and the choice of antibiotic and duration of treatment should be individualized based on the patient's specific needs and circumstances.

From the FDA Drug Label

Skin and skin structure infections caused by Staphylococcus aureus and/or Streptococcus pyogenes The treatment options for cellulitis include antibiotics such as:

• Cephalexin 2
• Dicloxacillin 3
• Nafcillin 4 These antibiotics are effective against Staphylococcus aureus and/or Streptococcus pyogenes, which are common causes of cellulitis.

From the Research

Treatment Options for Cellulitis

The treatment options for cellulitis include:

• Antibiotic therapy, with the choice of antibiotic depending on the severity and suspected causative organism of the infection 5, 6, 7, 8, 9
• For uncomplicated cellulitis, treatment should be directed against Streptococcus and methicillin-sensitive S. aureus, with expansion for methicillin-resistant S. aureus (MRSA) in cases of cellulitis associated with specific risk factors 6, 9
• Five days of treatment is sufficient, with extension if symptoms are not improved 5, 6
• Antibiotics with activity against community-associated MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, are preferred empiric therapy for outpatients with cellulitis in the community-associated MRSA-prevalent setting 8

Antibiotic Choices

Some studies suggest the following antibiotic choices for cellulitis:

• Levofloxacin, which appears to be as effective for 5 days as for 10 days in patients with uncomplicated cellulitis 5
• Cephalexin, which may not be as effective as trimethoprim-sulfamethoxazole or clindamycin in areas with a high prevalence of community-associated MRSA infections 8
• Trimethoprim-sulfamethoxazole, which has a higher treatment success rate than cephalexin and is a preferred empiric therapy for outpatients with cellulitis in the community-associated MRSA-prevalent setting 8
• Clindamycin, which may be more effective than cephalexin in patients with moderately severe cellulitis, obesity, or culture-confirmed MRSA infections 8

Considerations for Treatment

When treating cellulitis, it is essential to consider the following:

• The severity of the infection and the presence of any underlying medical conditions 6, 8
• The risk factors for MRSA, such as athletes, children, men who have sex with men, prisoners, military recruits, residents of long-term care facilities, those with prior MRSA exposure, and intravenous drug users 6
• The need for extension of treatment if symptoms are not improved after 5 days 5, 6