What is the treatment for finger cellulitis?

Treatment of Finger Cellulitis

For finger cellulitis, oral antibiotics active against streptococci, such as penicillin, amoxicillin, dicloxacillin, cephalexin (500 mg four times daily), or clindamycin are recommended as first-line treatment for 5 days. 1, 2

Initial Assessment and Antibiotic Selection

• For typical non-purulent finger cellulitis, select an antibiotic active against streptococci, which are the most common causative organisms 3, 1
• First-line oral options include:
  • Penicillin 1
  • Amoxicillin 1
  • Amoxicillin-clavulanate 3
  • Dicloxacillin 1
  • Cephalexin (500 mg four times daily) 1, 2
  • Clindamycin (for penicillin-allergic patients) 4
• Blood cultures or tissue aspirates are not routinely needed for typical cases of finger cellulitis 3, 1
• Consider cultures only if the patient has malignancy, severe systemic features, or unusual predisposing factors 3

Duration of Treatment

• A 5-day course of antimicrobial therapy is as effective as a 10-day course for uncomplicated cellulitis if clinical improvement occurs by day 5 3, 1, 2
• Extend treatment only if the infection has not improved within the initial 5-day period 1, 2
• Monitor for signs of improvement including decreased erythema, swelling, warmth, and tenderness 5

MRSA Considerations

• MRSA is an unusual cause of typical cellulitis, and treatment specifically targeting MRSA is usually unnecessary 3
• Consider MRSA coverage only in specific situations:
  • Cellulitis associated with penetrating trauma 2
  • Evidence of MRSA infection elsewhere 2
  • History of injection drug use 3
  • Purulent drainage 3, 2
  • Systemic inflammatory response syndrome (SIRS) 3
• If MRSA coverage is needed, options include:
  • Clindamycin alone 2
  • Combination of SMX-TMP or doxycycline with a β-lactam 3, 2

Adjunctive Measures

• Elevate the affected finger to promote gravity drainage of edema and inflammatory substances 3, 1, 2
• Address any predisposing factors that may have contributed to the infection 1
• Consider systemic corticosteroids (e.g., prednisone 40 mg daily for 7 days) in non-diabetic adult patients to reduce inflammation and hasten resolution 3, 2
• Some evidence suggests that adding an oral non-steroidal anti-inflammatory drug (such as ibuprofen 400 mg every 6 hours for 5 days) may hasten resolution of inflammation 6

Hospitalization Criteria

• Most patients with finger cellulitis can be treated as outpatients 1, 5
• Consider hospitalization if the patient has:
  • Systemic inflammatory response syndrome (SIRS) 3, 2
  • Altered mental status 3
  • Hemodynamic instability 3
  • Concern for deeper or necrotizing infection 3, 2
  • Poor adherence to therapy 3, 2
  • Severe immunocompromise 3, 2
  • Failure of outpatient treatment 3, 2

Prevention of Recurrence

• Identify and treat any predisposing conditions 1, 2
• For patients with frequent recurrences (3-4 episodes per year), consider prophylactic antibiotics such as oral penicillin, erythromycin, or intramuscular benzathine penicillin 1, 2

Common Pitfalls to Avoid

• Don't extend treatment unnecessarily beyond 5 days if clinical improvement has occurred 2
• Don't automatically add MRSA coverage for typical non-purulent cellulitis without specific risk factors 3, 2
• Don't overlook the importance of elevating the affected area to reduce edema 3, 2
• Be aware that venous stasis dermatitis, contact dermatitis, deep vein thrombosis, and panniculitis can mimic cellulitis 7, 8