Can a patient with cellulitis who is on medications receive Mvasi (bevacizumab)?

Bevacizumab (Mvasi) Administration in Patients with Cellulitis

Patients with active cellulitis who are on antibiotics should not receive Mvasi (bevacizumab) until the infection has completely resolved, as the presence of infection is a contraindication to bevacizumab administration. 1

Rationale for Recommendation

Bevacizumab (Mvasi) is an anti-angiogenic agent that inhibits vascular endothelial growth factor (VEGF), which plays a crucial role in wound healing and immune response. The presence of active infection like cellulitis presents several concerns:

1. Impaired Wound Healing:

   • Bevacizumab significantly impairs wound healing processes
   • Active cellulitis requires proper immune response and tissue repair, which would be compromised by bevacizumab

2. Infection Control Concerns:

   • Cellulitis is a bacterial infection of the deep dermis and subcutaneous tissue 2
   • The infection must be fully controlled before administering immunomodulating therapies
   • Even patients on antibiotics may have ongoing inflammatory processes that could be adversely affected

Management Approach

For Cellulitis Management:

• Ensure appropriate antibiotic therapy is administered:
  • 5-6 day course of antibiotics active against streptococci is recommended as first-line therapy 1
  • Beta-lactam antibiotics targeting beta-hemolytic streptococci are first choice for non-purulent cellulitis 1

Before Administering Mvasi:

• Confirm complete resolution of cellulitis:

  • Absence of erythema, warmth, swelling, and tenderness
  • Normal skin temperature in the affected area
  • Resolution of any systemic symptoms (fever, elevated WBC)

• Document resolution with:

  • Clinical examination showing normal skin appearance
  • Normalization of inflammatory markers if previously elevated

Important Considerations

• Cellulitis is often misdiagnosed, so ensure proper diagnosis before determining treatment course 3
• Severe pain and flu-like symptoms may delay recognition of cellulitis 4
• Consider that cellulitis can take 4-7 days to completely resolve even with appropriate antibiotic therapy 5
• Patients with recurrent cellulitis may require prophylactic antibiotics if they experience 3-4 episodes per year 6, 1

Potential Pitfalls

• Mistaking Pseudocellulitis for True Cellulitis: Conditions like venous stasis dermatitis, contact dermatitis, and lymphedema can mimic cellulitis 2
• Inadequate Treatment Duration: Ensure cellulitis is completely resolved, not just improved, before administering Mvasi
• Overlooking Predisposing Factors: Address underlying conditions such as edema, obesity, eczema, and venous insufficiency that may predispose to recurrent cellulitis 6, 1

By following these guidelines, clinicians can minimize risks associated with administering bevacizumab to patients with recent or active cellulitis, prioritizing patient safety and optimizing treatment outcomes.