From the Guidelines
For scrotal cellulitis, empiric antibiotic therapy should include coverage for skin flora, particularly Staphylococcus aureus and Streptococcus species, with a recommended duration of 5 days, but treatment should be extended if the infection has not improved within this time period 1.
Key Considerations
- First-line treatment typically involves oral antibiotics such as trimethoprim-sulfamethoxazole (TMP-SMX) 1-2 double-strength tablets twice daily, or cephalexin 500mg four times daily for 5-10 days.
- For patients with more severe infection, intravenous options include cefazolin 1-2g every 8 hours or vancomycin 15-20mg/kg every 12 hours (especially if MRSA is suspected) 1.
- Clindamycin 300-450mg orally three times daily is an alternative for penicillin-allergic patients.
- Patients should also be advised to elevate the scrotum, apply warm compresses, and take appropriate pain medication.
Important Recommendations
- Cultures of blood or cutaneous aspirates, biopsies, or swabs are not routinely recommended, but should be considered in patients with severe infection or immunodeficiency 1.
- Outpatient therapy is recommended for patients who do not have systemic signs of infection, altered mental status, or hemodynamic instability 1.
- Hospitalization is recommended if there is concern for a deeper or necrotizing infection, for patients with poor adherence to therapy, or for infection in a severely immunocompromised patient.
Potential Complications
- Scrotal cellulitis can progress rapidly due to the loose connective tissue in the area, potentially leading to Fournier's gangrene in severe cases.
- Patients should seek immediate medical attention if they develop fever, increasing pain, or spreading redness despite antibiotics.
From the FDA Drug Label
Adults: The usual dose of oral doxycycline is 200 mg on the first day of treatment (administered 100 mg every 12 hours) followed by a maintenance dose of 100 mg/day Acute epididymo-orchitis caused by N. gonorrhoeae: 100 mg, by mouth, twice a day for at least 10 days. Acute epididymo-orchitis caused by C. trachomatis: 100 mg, by mouth, twice a day for at least 10 days
The recommended dose of doxycycline for scrotal cellulitis is not directly stated, but considering the doses for similar conditions such as acute epididymo-orchitis, a dose of 100 mg, by mouth, twice a day can be considered. However, the exact duration of treatment is unclear. 2
From the Research
Scrotal Cellulitis Antibiotics
- The treatment of scrotal cellulitis involves the use of antibiotics, with the choice of antibiotic depending on the suspected causative organism 3.
- Beta-hemolytic streptococci are a common cause of scrotal cellulitis, and penicillin is often used as a first-line treatment 3, 4.
- In cases where methicillin-resistant Staphylococcus aureus (MRSA) is suspected, antibiotics such as trimethoprim-sulfamethoxazole or clindamycin may be used 5, 6.
- The use of cephalexin plus trimethoprim-sulfamethoxazole has been compared to cephalexin alone in the treatment of uncomplicated cellulitis, with mixed results 6.
- Clindamycin has been shown to be effective against some strains of MRSA, but its activity can be impacted by the size of the inoculum and the presence of inducible resistance 7.
Antibiotic Options
- Penicillin: effective against beta-hemolytic streptococci 3, 4
- Trimethoprim-sulfamethoxazole: effective against MRSA 5, 6
- Clindamycin: effective against some strains of MRSA, but activity can be impacted by inoculum size and inducible resistance 5, 7
- Cephalexin: may be used alone or in combination with trimethoprim-sulfamethoxazole for the treatment of uncomplicated cellulitis 6