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 a 5- to 6-day course of antibiotics active against streptococci, as recommended by the American College of Physicians 1. The treatment of oral cellulitis, a serious bacterial infection of the skin and tissues in the mouth, requires prompt antibiotic therapy to prevent complications.

Key Considerations

• The choice of antibiotic should be based on the severity of the infection and the patient's ability to self-monitor and have close follow-up with primary care.
• A cephalosporin, penicillin, or clindamycin are recommended treatment options, except for patients with evidence of MRSA infection or other specific conditions that require additional antimicrobial coverage 1.
• The duration of treatment is typically 5-7 days, as recommended by the National Institute for Health and Care Excellence (NICE) guideline 1.

Treatment Options

• Amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 5-6 days
• Clindamycin 300-450 mg four times daily for patients with penicillin allergies
• Cephalosporin or penicillin-based antibiotics for patients without MRSA infection or other specific conditions

Important Notes

• Insurance coverage for oral cellulitis treatment varies by plan, but most plans cover antibiotic medications and necessary dental procedures to address the source of infection.
• Prior authorization and referrals from primary care physicians may be required for certain procedures.
• Prompt treatment is essential to prevent serious complications, including airway compromise, cavernous sinus thrombosis, or sepsis.

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, is not explicitly mentioned in the provided studies 3, 4, 5, 6, 7.
• However, the studies discuss the treatment of cellulitis and other skin and skin-structure infections, which may be relevant to oral cellulitis.
• According to 3, the treatment of primary and recurrent cellulitis should initially cover Streptococcus and methicillin-sensitive S. aureus, with expansion for methicillin-resistant S. aureus (MRSA) in cases of cellulitis associated with specific risk factors.
• The study 4 found that oral antimicrobials are as effective as parenteral antimicrobials for the treatment of uncomplicated cellulitis.
• The study 5 discusses the treatment of anaerobic infections, which may be relevant to oral cellulitis, and recommends coverage of both anaerobic and aerobic organisms.
• The studies 6 and 7 discuss the efficacy and safety of various antimicrobial regimens for the treatment of skin and skin-structure infections, including amoxicillin/clavulanate and levofloxacin, which may be relevant to oral cellulitis.

Antimicrobial Coverage

• The antimicrobial coverage for oral cellulitis may include:
  • Streptococcus and methicillin-sensitive S. aureus 3
  • MRSA in cases of cellulitis associated with specific risk factors 3
  • Anaerobic and aerobic organisms 5
  • Amoxicillin/clavulanate and levofloxacin may be effective options 6, 7

Limitations

• The provided studies do not specifically address oral cellulitis, and the results may not be directly applicable to this condition.
• Further research is needed to determine the most effective antimicrobial coverage for oral cellulitis.