What is the recommended treatment for cellulitis (inflammation of the skin and subcutaneous tissues) resulting from a leg abrasion (scrape or cut) sustained while sliding during a softball game?

Treatment of Cellulitis from Softball Leg Abrasion

For cellulitis resulting from a leg abrasion sustained during softball, a 5-7 day course of cephalexin 500mg orally four times daily is the recommended first-line treatment, with reassessment after 5 days to determine if extension of therapy is needed. 1

Antibiotic Selection

First-line Options:

• Cephalexin 500mg orally four times daily 1, 2
  • Targets beta-hemolytic streptococci and methicillin-sensitive Staphylococcus aureus, which are the most common causative organisms in non-purulent cellulitis
  • Treatment duration: 5-7 days (extend if inadequate improvement)

Alternative Options (for penicillin-allergic patients):

• Clindamycin 600mg orally three times daily 1
• Doxycycline (not for children under 8 years) 1

Treatment Approach

1. Clean the wound thoroughly

   • Remove any remaining debris from the abrasion
   • Gently cleanse with mild soap and water

2. Elevate the affected leg to reduce swelling 1

3. Apply warm compresses to the affected area 1

4. Begin antibiotic therapy immediately

   • Do not delay treatment while waiting for culture results
   • Beta-lactam antibiotics (like cephalexin) are first choice for non-purulent cellulitis 1, 2

5. Consider adding an anti-inflammatory agent

   • NSAIDs may help reduce inflammation and hasten resolution 1, 3
   • Ibuprofen 400mg every 6 hours for 5 days has shown benefit in hastening resolution 3

Monitoring and Follow-up

• Reassess after 5 days of antibiotic therapy 1
• Extend treatment until 2-3 days after clinical resolution if inadequate improvement is seen 1
• Watch for warning signs requiring escalation of care:
  • Fever >38°C (100.4°F)
  • Rapidly spreading erythema
  • Increased pain
  • Systemic symptoms

Important Considerations

• Avoid TMP-SMX alone for non-purulent cellulitis as it has poor activity against streptococci 1
• Obtain cultures if there is purulent drainage or abscess formation 1
• Shorter antibiotic courses (5-6 days) are as effective as longer courses for uncomplicated cases 1
• Differentiate true cellulitis from mimickers such as contact dermatitis or venous stasis 2, 4

Prevention of Recurrence

• Keep the wound clean and covered with dry bandages 1
• Maintain good personal hygiene 1
• Address underlying conditions that may predispose to recurrent cellulitis:
  • Edema
  • Obesity
  • Skin disorders 1, 4

The Infectious Diseases Society of America guidelines strongly support this approach, emphasizing that most cases of cellulitis from community-acquired injuries can be effectively treated with targeted therapy against streptococci and methicillin-sensitive S. aureus 1, 2.