What is the coverage for oral cellulitis (infection of the skin and tissues in the mouth)?

From the Guidelines

Oral cellulitis should be treated with antibiotics that target streptococci, such as penicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, cephalexin, or clindamycin, for a duration of 5 days, as recommended by the Infectious Diseases Society of America 1. The standard treatment for oral cellulitis involves antibiotics that target common oral bacteria, particularly streptococci.

• For mild to moderate cases, amoxicillin-clavulanate is a suitable option, as it provides coverage against streptococci and other common oral pathogens.
• The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period, as stated in the practice guidelines for the diagnosis and management of skin and soft tissue infections 1.
• It is essential to note that the treatment should be tailored to the individual patient's needs, taking into account factors such as the severity of the infection, the presence of underlying medical conditions, and the patient's allergy history.
• In cases where the patient has a penicillin allergy, alternative antibiotics such as clindamycin may be used.
• The goal of treatment is to reduce morbidity, mortality, and improve quality of life by promptly and effectively managing the infection, as the infection can spread rapidly through facial planes and potentially lead to airway compromise or systemic infection.
• Patients should verify their specific coverage details with their insurance provider, as plans vary in terms of deductibles, copayments, and prior authorization requirements for certain procedures.
• The treatment should also include addressing the underlying cause of the infection, such as tooth extraction or root canal therapy, to prevent recurrence and improve outcomes.

From the FDA Drug Label

1. 4 Uncomplicated Skin and Skin Structure Infections A randomized, double-blind, controlled clinical trial conducted in the U. S. compared the efficacy of moxifloxacin 400 mg once daily for seven days with cephalexin hydrochloride 500 mg three times daily for seven days. The percentage of patients treated for uncomplicated abscesses was 30%, furuncles 8%, cellulitis 16%, impetigo 20%, and other skin infections 26% Clinical success rates in evaluable patients were 89% (108/122) for moxifloxacin hydrochloride and 91% (110/121) for cephalexin hydrochloride.

The coverage for oral cellulitis is not explicitly mentioned in the provided drug label. However, the label does mention cellulitis as one of the conditions treated in the study of uncomplicated skin and skin structure infections, with a percentage of 16% of patients treated for this condition.

• Clinical success rate for moxifloxacin hydrochloride in treating uncomplicated skin and skin structure infections, including cellulitis, was 89%. However, the label does not provide specific information about oral cellulitis. 2

From the Research

Coverage for Oral Cellulitis

• The coverage for oral cellulitis, an infection of the skin and tissues in the mouth, typically involves antibiotics that target the most common causative bacteria, including Streptococcus and Staphylococcus aureus 3.
• The initial treatment should cover Streptococcus and methicillin-sensitive S. aureus, with expansion to cover methicillin-resistant S. aureus (MRSA) in cases with specific risk factors 3.
• Oral antibiotics are often sufficient for uncomplicated cellulitis, with intravenous (IV) antibiotics reserved for more severe cases or those with specific risk factors 4, 5.
• Studies have compared the efficacy of oral versus IV antibiotic administration for cellulitis infections, with some finding no significant difference in outcomes between the two routes of administration 4, 5.
• Specific antibiotics used to treat oral cellulitis include clindamycin, ampicillin/sulbactam, and moxifloxacin, which have been shown to be effective against the common pathogens involved in odontogenic infections 6, 7.

Antibiotic Options

• Clindamycin and ampicillin/sulbactam have been compared in the treatment of facial cellulitis of odontogenic origin in children, with both showing high efficacy 6.
• Moxifloxacin has been compared to a clindamycin/ceftriaxone combination in the management of odontogenic maxillofacial infectious processes, with moxifloxacin showing potential as a convenient and rational alternative 7.
• The choice of antibiotic should be based on the severity of the infection, the presence of specific risk factors, and the susceptibility of the causative pathogens 3, 4, 5, 6, 7.