From the Guidelines
The treatment of tinea pedis with concurrent cellulitis requires a dual approach, addressing both the fungal infection and the bacterial complication, with oral antibiotics such as dicloxacillin, cephalexin, or clindamycin for 7-10 days, and topical antifungal medications like terbinafine, clotrimazole, or miconazole for 2-4 weeks, as recommended by the Infectious Diseases Society of America 1. For the cellulitis component, oral antibiotics are necessary, typically dicloxacillin 500 mg four times daily, cephalexin 500 mg four times daily, or clindamycin 300-450 mg three times daily for 7-10 days. If MRSA is suspected, consider trimethoprim-sulfamethoxazole (TMP-SMX) or doxycycline, as suggested by the 2018 WSES/SIS-E consensus conference 1. Some key points to consider in the treatment of cellulitis include:
- The use of antibiotics effective against streptococci, such as penicillin, amoxicillin, or cephalexin, as recommended by the Infectious Diseases Society of America 1.
- The consideration of MRSA coverage in cases of suspected MRSA infection, with options including vancomycin, linezolid, or daptomycin, as recommended by the Infectious Diseases Society of America 1.
- The importance of addressing underlying conditions, such as tinea pedis, to prevent recurrent cellulitis, as highlighted by the 2018 WSES/SIS-E consensus conference 1. For the tinea pedis, apply topical antifungal medications such as terbinafine 1% cream twice daily, clotrimazole 1% cream twice daily, or miconazole 2% cream twice daily for 2-4 weeks. In severe cases, oral antifungals may be needed, such as terbinafine 250 mg daily for 2 weeks or fluconazole 150 mg weekly for 2-4 weeks, as recommended by the Infectious Diseases Society of America 1. Additionally, keep the feet clean and dry, change socks daily, avoid walking barefoot in public areas, and use moisture-wicking socks. Elevate the affected limb to reduce swelling, and consider over-the-counter pain relievers for discomfort. This dual approach is necessary because untreated fungal infection can create skin breaks that allow bacteria to enter, causing recurrent cellulitis, as highlighted by the 2018 WSES/SIS-E consensus conference 1. If symptoms worsen or don't improve within 48-72 hours of antibiotic treatment, medical reassessment is needed, as recommended by the Infectious Diseases Society of America 1.
From the Research
Treatment of Tinea Pedis with Concurrent Cellulitis
- The treatment of tinea pedis with concurrent cellulitis is not directly addressed in the provided studies, however, the studies do discuss the treatment of tinea pedis in general 2, 3, 4, 5, 6.
- According to the studies, oral antifungal therapy is usually used for chronic conditions or when topical treatment has failed 2, 3, 4, 5.
- The studies suggest that terbinafine is more effective than griseofulvin in treating tinea pedis 2, 4, 5.
- Itraconazole and terbinafine have been shown to be effective in treating tinea pedis, with no significant difference between the two treatments 6.
- Topical antifungal therapy is the mainstay of treatment for superficial or localized tinea pedis, with examples of topical antifungal agents including allylamines, azoles, benzylamine, ciclopirox, tolnaftate, and amorolfine 3.
- Combined therapy with topical and oral antifungals may increase the cure rate 3.
Oral Antifungal Agents
- Terbinafine, itraconazole, and fluconazole are oral antifungal agents used to treat tinea pedis 2, 3, 4, 5, 6.
- The choice of oral antifungal agent depends on the severity of the infection, the presence of concomitant conditions such as onychomycosis, and the patient's immune status 3.