What is the treatment for cellulitis?

From the Guidelines

Cellulitis should be treated with antibiotics active against streptococci, with a recommended duration of 5 days, and elevation of the affected area to promote gravity drainage of edema and inflammatory substances 1. The treatment of cellulitis depends on the severity of the infection, with mild cases typically managed with oral antibiotics and more severe cases requiring intravenous antibiotics in a hospital setting.

• For mild cases, oral antibiotics such as penicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, cephalexin, or clindamycin are suitable options 1.
• In cases of uncomplicated cellulitis, a 5-day course of antimicrobial therapy is as effective as a 10-day course, if clinical improvement has occurred by 5 days 1.
• Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are also recommended 1.
• It is essential to complete the full course of antibiotics, even if symptoms improve, and to seek immediate medical attention if signs of worsening infection occur, such as fever, increasing pain, or red streaking from the infection site 1.
• In some cases, cutaneous inflammation and systemic features may worsen after initiating therapy, probably due to the sudden destruction of pathogens releasing potent enzymes that increase local inflammation, and systemic corticosteroids may be considered as an optional adjunct for treatment of uncomplicated cellulitis and erysipelas in selected adult patients 1.

From the FDA Drug Label

The cure rates in clinically evaluable patients with complicated skin and skin structure infections were 90% in linezolid-treated patients and 85% in oxacillin-treated patients The cure rates by pathogen for microbiologically evaluable patients are presented in Table 18. The treatment for cellulitis, which is a type of skin and skin structure infection, is linezolid (ZYVOX), with a recommended dosage of 600 mg IV or oral every 12 hours for 10 to 14 days.

• Key points:
  • Linezolid is effective against MRSA and other Gram-positive pathogens.
  • The cure rate for linezolid-treated patients with complicated skin and skin structure infections was 90%.
  • The recommended treatment duration is 10 to 14 days. 2

From the Research

Treatment Options for Cellulitis

• The treatment for cellulitis typically involves the use of antibiotics, with the goal of resolving the infection and preventing further complications 3, 4, 5.
• A study published in 2004 found that a 5-day course of levofloxacin was as effective as a 10-day course in treating uncomplicated cellulitis 3.
• Another study published in 2023 aimed to compare the efficacy of oral versus intravenous antibiotic administration for cellulitis infections, but the results are still pending 4.
• A 2024 study found that oral beta-lactam therapy was as effective as outpatient parenteral antimicrobial therapy in treating cellulitis, with similar outcomes and tolerability 5.

Antibiotic Regimens

• Common antibiotic regimens for cellulitis include beta-lactam antibiotics such as cefazolin and flucloxacillin, as well as levofloxacin 3, 5.
• The choice of antibiotic regimen may depend on the severity of the infection, the presence of underlying medical conditions, and the risk of antibiotic resistance 4, 6.
• A 2005 study found that the addition of an oral nonsteroidal anti-inflammatory agent to antibiotic treatment hastened the resolution of cellulitis-related inflammation 7.

Route of Administration

• Both oral and intravenous routes of antibiotic administration have been used to treat cellulitis, with the choice of route depending on the severity of the infection and the patient's ability to tolerate oral medications 4, 5.
• A 2024 study found that oral antibiotic therapy was effective in treating cellulitis, with a significant reduction in the use of outpatient parenteral antimicrobial therapy 5.

Adjunctive Therapies

• The use of anti-inflammatory agents, such as ibuprofen, has been shown to hasten the resolution of cellulitis-related inflammation when used in conjunction with antibiotic therapy 7.
• The role of adjunctive therapies in the treatment of cellulitis is still being studied, and further research is needed to determine their efficacy and safety 7, 6.