From the Guidelines
Oral corticosteroids are not the primary treatment for cellulitis and should only be considered in specific cases with significant inflammation under the guidance of a specialist. The standard treatment for cellulitis involves antibiotics that target the most common causative bacteria, typically beta-lactam antibiotics like cephalexin or dicloxacillin for 5-10 days, depending on severity [ 1 ]. For patients with penicillin allergies, clindamycin or trimethoprim-sulfamethoxazole are appropriate alternatives.
Key Considerations
- The use of systemic corticosteroids, such as prednisone, could be considered in nondiabetic adult patients with cellulitis, but this is based on weak, moderate evidence [ 1 ].
- Steroids may actually worsen infection by suppressing the immune response needed to fight bacterial infections.
- They can also mask important clinical signs of worsening infection, potentially leading to delayed appropriate treatment.
Treatment Approach
- The focus should remain on appropriate antibiotic therapy, elevation of the affected area, and pain management.
- If symptoms worsen despite oral antibiotics, patients should seek immediate medical attention as intravenous antibiotics may be necessary.
Special Considerations
- The decision to use steroids in cases of severe inflammatory reactions should be made by a specialist on a case-by-case basis, weighing the potential benefits against the risks [ 1 ].
From the Research
Effectiveness of Oral Corticosteroids for Treating Cellulitis
- There is no direct evidence in the provided studies to support the effectiveness of oral corticosteroids (steroids) for treating cellulitis 2, 3, 4, 5, 6.
- The studies focus on the use of antibiotics, such as beta-lactam antibiotics, cephalosporins, flucloxacillin, and phenoxymethylpenicillin, for the treatment of cellulitis 2, 3, 5.
- One study suggests that the addition of an oral anti-inflammatory agent, such as ibuprofen, to antibiotic treatment may hasten the resolution of cellulitis-related inflammation 4.
- Another study reports the use of oral ciprofloxacin and clindamycin as a primary treatment for orbital cellulitis, with positive results 6.
- The use of oral corticosteroids is not mentioned in the provided studies as a treatment option for cellulitis.
Treatment Options for Cellulitis
- Uncomplicated cellulitis can be managed in the outpatient setting with oral antibiotics 3.
- Recurrent cellulitis is common, and predisposing conditions should be assessed for and treated at the time of initial diagnosis 3.
- Antimicrobial prophylaxis can be effective for patients with frequent recurrences despite management of underlying conditions 3.
- The choice of antibiotic and route of administration may vary depending on the severity of the infection and the patient's overall health 2, 5, 6.