From the Guidelines
For cellulitis of the neck, I recommend empiric treatment with intravenous antibiotics that cover both Staphylococcus aureus and Streptococcus species, the most common causative organisms, as suggested by the Infectious Diseases Society of America guidelines 1.
Key Considerations
- Initial therapy should include either cefazolin 1-2g IV every 8 hours or clindamycin 600-900mg IV every 8 hours if the patient has a penicillin allergy.
- If MRSA is suspected based on risk factors or local prevalence, vancomycin 15-20mg/kg IV every 12 hours (adjusted based on levels) or daptomycin 4-6mg/kg IV daily should be used, as recommended by the guidelines 1.
Treatment Duration and Monitoring
- Treatment duration is typically 5 days, but should be extended if the infection has not improved within this time period, as stated in the guidelines 1.
- Close monitoring for signs of deeper infection (increasing pain, difficulty swallowing or breathing) is essential, and elevation of the head of bed and adequate pain control are important adjunctive measures.
Switching to Oral Antibiotics
- Consider switching to oral antibiotics (such as cephalexin 500mg four times daily or clindamycin 300-450mg four times daily) after 2-3 days if clinical improvement occurs.
Imaging and Surgical Intervention
- If there is no improvement within 48-72 hours, imaging should be considered to rule out abscess formation or deeper infection requiring surgical intervention, as suggested by the guidelines 1.
From the Research
Antibiotic Recommendations for Cellulitis of the Neck
- The majority of non-purulent, uncomplicated cases of cellulitis are caused by β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus 2.
- Appropriate targeted coverage of this pathogen with oral antibiotics such as:
- Penicillin
- Amoxicillin
- Cephalexin is sufficient for non-purulent cellulitis 2.
- For patients with more severe cellulitis, intravenous (IV) antibiotic therapy may be preferred 3.
- However, there is no association between the route of antibiotic administration (IV or oral) and the duration of antibiotic therapy with clinical outcome 3, 4.
- A study comparing oral versus intravenous antibiotics administration for cellulitis infection is currently underway, with results expected to provide evidence-based guidelines for treatment 5.
- Cephazolin 2 g twice daily has been shown to be effective in treating cellulitis in a supervised outpatient programme 6.
- A systematic review and meta-analysis found that there is no evidence to support the superiority of any one antibiotic over another, and that antibiotics with activity against methicillin-resistant Staphylococcus aureus did not add an advantage 4.
Key Points to Consider
- The choice of antibiotic and route of administration should be based on the severity of the cellulitis and the patient's individual needs.
- The duration of antibiotic therapy should be based on the clinical response of the patient, rather than a fixed duration 3, 4.
- Further research is needed to provide evidence-based guidelines for the treatment of cellulitis 5, 4.