Best Oral Medication for Uncomplicated Cellulitis
For uncomplicated cellulitis, the best oral medication is a beta-lactam antibiotic such as penicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, or cephalexin, which target streptococci, the primary causative pathogen. 1, 2
First-Line Treatment Options
- Penicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, or cephalexin are recommended as first-line oral antibiotics for typical uncomplicated cellulitis 1, 2
- Clindamycin is another appropriate option for patients with penicillin allergies 1, 2
- A 5-day course of antimicrobial therapy is as effective as a 10-day course if clinical improvement occurs by day 5 1, 3
Pathogen Considerations
- Cellulitis is primarily caused by beta-hemolytic streptococci, particularly group A streptococcus 2
- MRSA is an unusual cause of typical uncomplicated cellulitis 1, 2
- Coverage for MRSA is not routinely necessary for typical cellulitis unless specific risk factors are present 1
When to Consider MRSA Coverage
MRSA coverage may be appropriate in specific situations:
- Cellulitis associated with penetrating trauma 1, 2
- Purulent drainage present 1
- Evidence of MRSA infection elsewhere 1
- History of MRSA colonization 1
- Injection drug use 1
- Systemic inflammatory response syndrome (SIRS) 1
MRSA Coverage Options (when indicated)
- Trimethoprim-sulfamethoxazole (TMP-SMX) 1, 4
- Doxycycline or minocycline 1
- Clindamycin (covers both streptococci and MRSA) 1, 4
- Linezolid (for severe infections or treatment failures) 1, 5
Treatment Duration
- 5 days of therapy is recommended for uncomplicated cellulitis if clinical improvement occurs 1, 3
- Treatment should be extended if the infection has not improved within 5 days 1
- A randomized controlled trial demonstrated that 5 days of levofloxacin was as effective as 10 days for uncomplicated cellulitis 3
Adjunctive Measures
- Elevation of the affected area to reduce edema 1, 2
- Treatment of predisposing factors such as edema, venous insufficiency, or underlying cutaneous disorders 1, 2
- Careful examination and treatment of interdigital toe spaces to eradicate colonization with pathogens and reduce recurrent infection 1
Common Pitfalls to Avoid
- Unnecessarily prescribing MRSA coverage for typical cellulitis without risk factors 1, 6
- Using antibiotics with inadequate streptococcal coverage for typical cellulitis 2
- Failing to distinguish between purulent and non-purulent cellulitis, which affects treatment choices 1
- Not addressing predisposing factors, which can lead to recurrent infections 1, 7
- Using unnecessarily prolonged antibiotic courses when 5 days is typically sufficient 1, 3