From the Guidelines
Vancomycin is the empiric intravenous (IV) antibiotic of choice for cellulitis, particularly in cases with systemic signs of infection or risk factors for MRSA, such as penetrating trauma, evidence of MRSA infection elsewhere, nasal colonization with MRSA, injection drug use, purulent drainage, or SIRS 1.
Key Considerations
- For typical cases of cellulitis without systemic signs of infection, an antimicrobial agent active against streptococci is recommended 1.
- In cases of uncomplicated cellulitis, a 5-day course of antimicrobial therapy is as effective as a 10-day course, if clinical improvement has occurred by 5 days 1.
- For patients with severe infection, vancomycin plus either piperacillin-tazobactam or imipenem-meropenem is recommended as a reasonable empiric regimen 1.
- Empirical therapy for MRSA should be considered pending culture data in hospitalized patients with complicated SSTI 1.
Important Details
- The choice of antibiotic should be based on the severity of the infection, the presence of systemic signs, and the patient's underlying health status 1.
- Vancomycin is a suitable option for empirical coverage of CA-MRSA in outpatients with SSTI, as well as for hospitalized patients with complicated SSTI 1.
- Other options for empirical coverage of CA-MRSA include clindamycin, TMP-SMX, and tetracyclines 1.
From the Research
Empiric Intravenous (IV) Antibiotic for Cellulitis
The choice of empiric intravenous (IV) antibiotic for cellulitis depends on various factors, including the likelihood of methicillin-resistant Staphylococcus aureus (MRSA) infection and the patient's risk factors.
- According to 2, cephalexin is a cost-effective option for outpatient management of cellulitis at current estimated MRSA levels.
- However, 3 suggests that linezolid may be a suitable choice for empirical treatment of cellulitis in complicated or compromised patients, particularly when the likelihood of a resistant pathogen is high.
- The study 2 also notes that clindamycin becomes a more cost-effective therapy at high likelihoods of MRSA infection.
- Additionally, 4 emphasizes the importance of considering patient risk factors and regional susceptibility patterns when selecting empiric antimicrobial therapy for cellulitis.
Factors Influencing Antibiotic Choice
Several factors can influence the choice of empiric IV antibiotic for cellulitis, including:
- Probability of MRSA infection 2
- Patient risk factors, such as diabetes, obesity, and old age 5
- Regional susceptibility patterns 4
- Cost-effectiveness of different antibiotic options 2, 3
Current Guidelines and Research
- The study 6 aims to compare the efficacy of oral versus intravenous antibiotic administration for cellulitis infections, which may provide further guidance on the optimal route of administration.
- The review 5 highlights the importance of considering non-infectious causes of local symptoms and the need for further research on the pathophysiology and clinical management of cellulitis.