From the Guidelines
Cellulitis treatment typically involves a 5- to 6-day course of antibiotics active against streptococci.
Key Considerations
- The choice of antibiotic should be based on the severity of the infection and the presence of any underlying conditions, such as penetrating trauma or evidence of MRSA infection 1.
- For patients with nonpurulent cellulitis, oral antibiotics such as penicillin, amoxicillin, or clindamycin are suitable options 1.
- In cases where MRSA is suspected, empiric therapy with vancomycin or another antimicrobial effective against both MRSA and streptococci is recommended 1.
- The duration of antimicrobial therapy should be individualized based on the patient's clinical response, but a 5- to 7-day course is commonly recommended 1.
- Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are also important aspects of cellulitis management 1.
- For patients with severe or complicated infections, hospitalization and parenteral antibiotics may be necessary 1.
Antibiotic Options
- Cephalosporins, such as cephalexin, are effective against streptococci and can be used as first-line therapy 1.
- Clindamycin is an alternative option for patients with suspected MRSA or those who are allergic to penicillin 1.
- Fluoroquinolones are not recommended for the treatment of MRSA infections, but can be used for uncomplicated cellulitis in areas where CA-MRSA is not prevalent 1.
From the Research
Treatment of Cellulitis
The treatment of cellulitis typically involves empiric antimicrobial therapy based on patient risk factors and regional susceptibility patterns 2. The majority of cases of cellulitis are nonculturable, and therefore the causative bacteria are unknown, but most identified cases are due to β-hemolytic Streptococcus and Staphylococcus aureus 3.
- Initial treatment should cover Streptococcus and methicillin-sensitive S. aureus, with expansion for methicillin-resistant S. aureus (MRSA) in cases of cellulitis associated with specific risk factors 3
- Five days of treatment is sufficient, with extension if symptoms are not improved 3
- Treatment of uncomplicated cellulitis should be directed against Streptococcus and methicillin-sensitive S. aureus 3
- Failure to improve with appropriate first-line antibiotics should prompt consideration for resistant organisms, secondary conditions that mimic cellulitis, or underlying complicating conditions such as immunosuppression, chronic liver disease, or chronic kidney disease 3
Management Approaches
Management of cellulitis and soft tissue infections varies according to the type of infection 4.
- The foundations of treatment are drainage of purulence and antibiotics, the latter targeted at the infection's most likely cause 4
- Imaging may be helpful for characterizing purulent soft tissue infections and associated osteomyelitis 4
- Loop drainage is preferred over the traditional incision and drainage technique for abscesses, and adjunctive antibiotics can be considered 5
- Most patients can be managed as outpatient 5
Diagnosis and Prevention
Diagnosis of cellulitis is based primarily on history and physical examination 3, 4.