From the Guidelines
Cellulitis treatment should involve a 5- to 6-day course of antibiotics active against streptococci, particularly for patients able to self-monitor and who have close follow-up with primary care 1.
Assessment and Treatment
Cellulitis assessment requires evaluation of the affected area for redness, warmth, swelling, and pain, along with checking for fever, chills, and lymph node enlargement.
- Treatment typically involves oral antibiotics for mild to moderate cases, with cephalexin or dicloxacillin being first-line options.
- For patients with penicillin allergies, clindamycin or doxycycline are appropriate alternatives.
- Severe cases may require intravenous antibiotics like cefazolin or vancomycin for MRSA concerns.
Key Considerations
- During treatment, elevate the affected limb, mark the border of redness to monitor progression, ensure adequate pain control with acetaminophen or ibuprofen, and maintain good hydration.
- Patients should seek immediate medical attention if they develop high fever, increasing pain, rapid spread of redness beyond marked borders, or development of blisters or black areas.
- Cellulitis is caused by bacterial invasion of the skin, commonly by Streptococcus or Staphylococcus species, which triggers inflammation and immune response.
Preventing Recurrences
- Measures to reduce recurrences of cellulitis include treating interdigital maceration, keeping the skin well hydrated with emollients to avoid dryness and cracking, and reducing any underlying edema.
- For patients with recurrent cellulitis, prophylactic antibiotics or oral antibiotics to initiate therapy as soon as symptoms of infection begin may be considered 1.
From the FDA Drug Label
Skin and skin structure infections caused by Staphylococcus aureus and/or Streptococcus pyogenes The assessment and treatment for cellulitis may involve the use of cephalexin for skin and skin structure infections caused by susceptible strains of Staphylococcus aureus and/or Streptococcus pyogenes 2.
- Key points:
- Cephalexin is indicated for skin and skin structure infections caused by Staphylococcus aureus and/or Streptococcus pyogenes.
- Culture and susceptibility tests should be initiated prior to and during therapy.
- Renal function studies should be performed when indicated. However, the provided drug labels do not explicitly discuss the assessment of cellulitis.
From the Research
Assessment of Cellulitis
- The assessment of cellulitis involves evaluating the severity of the infection, which can be done by measuring the affected skin surface area, C-reactive protein levels, and systemic inflammatory response syndrome score 3.
- Patients with more severe cellulitis are more likely to require intravenous antibiotic therapy 3.
Treatment of Cellulitis
- The treatment of cellulitis typically involves the use of antibiotics, with the choice of antibiotic depending on the severity of the infection and the presence of methicillin-resistant Staphylococcus aureus (MRSA) 4, 5.
- Oral antibiotics such as trimethoprim-sulfamethoxazole, cephalexin, and clindamycin are commonly used to treat cellulitis, with trimethoprim-sulfamethoxazole and clindamycin being preferred in areas with a high prevalence of MRSA 5.
- The use of broad-spectrum antibiotics is not always necessary and may be unjustified in cases of uncomplicated cellulitis 6.
- The addition of an oral anti-inflammatory agent to antibiotic therapy may hasten the resolution of cellulitis-related inflammation 7.
- The route of antibiotic administration (intravenous or oral) does not appear to affect the outcome of treatment, and oral therapy may be sufficient for patients with less severe cellulitis 3.
- The duration of antibiotic therapy is not well established, but there is no evidence to suggest that a course length of more than 5 days results in additional benefit 3.