From the Guidelines
Cellulitis treatment should typically involve a 5- to 6-day course of antibiotics active against streptococci, particularly for patients able to self-monitor and who have close follow-up with primary care. For mild cases, oral antibiotics such as cephalexin (500 mg four times daily), dicloxacillin (500 mg four times daily), or clindamycin (300-450 mg three times daily) are usually effective 1. More severe cases may require intravenous antibiotics like ceftriaxone, vancomycin, or piperacillin-tazobactam in a hospital setting.
Key Considerations
- Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended 1.
- 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.
- Patients should receive appropriate therapy for any underlying condition that may have predisposed to the infection, such as tinea pedis, venous eczema, or trauma.
- Measures to reduce recurrences of cellulitis include treating interdigital maceration, keeping the skin well hydrated with emollients to avoid dryness and cracking, and reducing any underlying edema by such methods as elevation of the extremity, compressive stockings or pneumatic pressure pumps, and, if appropriate, diuretic therapy 1.
Antibiotic Selection
- Suitable agents for oral therapy include dicloxacillin, cephalexin, clindamycin, or erythromycin, unless streptococci or staphylococci resistant to these agents are common in the community 1.
- For parenteral therapy, reasonable choices include a penicillinase-resistant penicillin such as nafcillin, a first-generation cephalosporin such as cefazolin, or, for patients with life-threatening penicillin allergies, clindamycin or vancomycin 1.
Monitoring and Follow-up
- Patients should be monitored for signs of improvement or worsening of the infection, and antibiotic therapy should be adjusted as needed.
- Follow-up with primary care is essential to ensure that the infection is fully resolved and to address any underlying conditions that may have contributed to the development of cellulitis.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION The penicillinase-resistant penicillins are available for oral administration and for intramuscular and intravenous injection. Bacteriologic studies to determine the causative organisms and their sensitivity to the penicillinase-resistant penicillins should always be performed. Duration of therapy varies with the type and severity of infection as well as the overall condition of the patient, therefore, it should be determined by the clinical and bacteriological response of the patient In severe staphylococcal infections, therapy with penicillinase-resistant penicillins should be continued for at least 14 days. Therapy should be continued for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative.
Cellulitis Treatment:
- The provided drug labels do not explicitly mention cellulitis treatment.
- However, dicloxacillin 2 is a penicillinase-resistant penicillin that can be used to treat various infections, including those caused by Staphylococcus and Streptococcus species, which are common causes of cellulitis.
- Clindamycin 3 can also be used to treat serious infections, including those caused by anaerobic bacteria, but its use in cellulitis treatment is not explicitly mentioned in the provided label.
- The treatment of cellulitis typically involves antibiotics, and the choice of antibiotic depends on the severity and suspected causative organisms of the infection.
- The duration of therapy varies with the type and severity of infection, as well as the overall condition of the patient.
From the Research
Cellulitis Treatment Overview
- Cellulitis is a common skin infection that can be challenging to diagnose and treat due to its non-specific symptoms and lack of a gold standard diagnostic test 4.
- The majority of non-purulent, uncomplicated cases of cellulitis are caused by β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus, and can be treated with oral antibiotics such as penicillin, amoxicillin, and cephalexin 4.
Antibiotic Therapy
- Oral beta-lactam therapy (OBLT) using oral flucloxacillin plus probenecid has been shown to be effective and tolerable for the treatment of cellulitis, with similar outcomes to outpatient parenteral antimicrobial therapy (OPAT) 5.
- There is no evidence to support the superiority of any one antibiotic over another, and antibiotics with activity against methicillin-resistant Staphylococcus aureus do not add an advantage 6.
- The route of antibiotic administration (oral vs. intravenous) does not appear to affect clinical outcome, and treatment duration of longer than 5 days is not supported by evidence 7, 6.
Treatment Duration and Route of Administration
- A study found that patients given only oral therapy were more likely to have improved at day 5 compared to those given at least a single dose of intravenous therapy, and were as likely to be back to their normal activities at day 10 and day 30 7.
- Another study found that the duration of antibiotic therapy was not associated with outcome as measured at day 10 and day 30 7.
- A systematic review and meta-analysis found that there is low-quality evidence to support the most appropriate agent, route of administration, and duration of treatment for patients with cellulitis 6.