What is the treatment for cellulitis?

From the Guidelines

Cellulitis treatment should include an antibiotic active against streptococci, with oral antibiotics recommended for 5 days if clinical improvement occurs, as stated in the 2014 update by the Infectious Diseases Society of America 1. For mild to moderate uncomplicated cellulitis, first-line options include:

• Penicillin
• Amoxicillin
• Amoxicillin-clavulanate
• Dicloxacillin
• Cephalexin
• Clindamycin for penicillin-allergic patients 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. In addition to antibiotics, elevating the affected area, applying warm compresses, and taking over-the-counter pain relievers like acetaminophen or ibuprofen can help manage symptoms. Proper wound care is essential if there's an entry point for infection. Patients should seek immediate medical attention if they develop high fever, increasing pain, red streaking from the infection site, or if the area continues to worsen despite 48 hours of antibiotics. These treatments target the bacterial infection while reducing inflammation and pain, allowing the body's immune system to effectively clear the infection. It is also recommended to treat any underlying conditions that may have predisposed to the infection, such as tinea pedis, venous eczema, or trauma, as stated in the guidelines 1. For more severe cases or those with systemic symptoms, intravenous antibiotics may be necessary, such as cefazolin, nafcillin, or vancomycin if MRSA is suspected, as recommended in the guidelines 1. Overall, the goal of treatment is to reduce morbidity, mortality, and improve quality of life by effectively managing the infection and its symptoms.

From the Research

Cellulitis Treatment Overview

• Cellulitis is a condition that requires prompt treatment, typically with antibiotics 2, 3, 4, 5, 6.
• The choice of antibiotic and duration of treatment can vary depending on the severity of the condition and the presence of certain bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) 3, 4, 6.

Antibiotic Treatment Options

• Levofloxacin has been shown to be effective in treating uncomplicated cellulitis, with a 5-day course being as effective as a 10-day course 2.
• Trimethoprim-sulfamethoxazole and clindamycin have been found to be effective in treating cellulitis, particularly in areas with a high prevalence of MRSA 3.
• Cephalexin is also commonly used to treat cellulitis, but its effectiveness may be lower than that of trimethoprim-sulfamethoxazole 3, 6.
• The combination of cephalexin and trimethoprim-sulfamethoxazole has been studied, but its benefits over cephalexin alone are unclear 6.

Duration of Treatment

• The optimal duration of antibiotic treatment for cellulitis is not well established, but studies suggest that a shorter course of treatment (5-7 days) may be sufficient for uncomplicated cases 2, 5.
• The route of antibiotic administration (oral vs. intravenous) does not appear to affect outcomes in patients with similar severity of cellulitis 5.

Considerations for Treatment

• The presence of MRSA can affect the choice of antibiotic treatment, with trimethoprim-sulfamethoxazole and clindamycin being more effective against this bacteria 3, 4.
• The severity of cellulitis, as well as the presence of underlying medical conditions, can also influence the choice of treatment and duration of therapy 3, 4, 5.