What is the treatment for cellulitis using ceftriaxone (Ceftriaxone) injection?

From the Guidelines

Ceftriaxone injection is a recommended treatment for moderate to severe cellulitis, particularly for patients with suspected streptococcal infection, as it provides effective coverage against this common causative organism 1.

Key Considerations for Treatment

• The dose of ceftriaxone typically ranges from 1-2 grams intravenously once daily, with treatment duration usually ranging from 5-14 days, depending on the severity of infection and clinical response.
• Ceftriaxone is a third-generation cephalosporin antibiotic that works by inhibiting bacterial cell wall synthesis, making it effective against many common cellulitis-causing organisms including Streptococcus and many strains of Staphylococcus.
• For outpatient treatment, once-daily dosing may be administered at infusion centers, and patients should elevate the affected limb, monitor for improvement of redness, swelling, and pain, and watch for potential side effects including diarrhea, rash, or signs of allergic reaction.

Special Considerations

• If MRSA is suspected, additional coverage with antibiotics like vancomycin may be necessary, as ceftriaxone does not provide adequate coverage against this organism 1.
• Transition to oral antibiotics is appropriate when clinical improvement is observed, typically after 2-3 days of intravenous therapy, and adequate hydration should be maintained during treatment.
• Patients should seek immediate medical attention if symptoms worsen despite therapy, as this may indicate the need for alternative or additional treatments.

Evidence-Based Recommendations

• The 2019 National Institute for Health and Care Excellence (NICE) guideline recommends a course of 5 to 7 days of antibiotics for uncomplicated cellulitis 1.
• The American College of Physicians recommends considering a shorter course of antibiotics, such as 5-7 days, for patients with uncomplicated cellulitis, as this may help reduce the risk of antibiotic resistance and side effects 1.

From the FDA Drug Label

SKIN AND SKIN STRUCTURE INFECTIONS Caused by Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Viridans group streptococci, Escherichia coli, Enterobacter cloacae, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, Morganella morganii,1Pseudomonas aeruginosa, Serratia marcescens, Acinetobacter calcoaceticus, Bacteroides fragilis1or Peptostreptococcus species

Ceftriaxone injection is indicated for the treatment of skin and skin structure infections, including cellulitis, caused by susceptible organisms such as Staphylococcus aureus and Streptococcus pyogenes 2.

From the Research

Cellulitis Treatment with Ceftriaxone Injection

• Ceftriaxone is recognized as safe and effective for skin and soft tissue infections, including cellulitis, when administered intravenously or intramuscularly 3.
• The drug's long serum half-life allows it to be given every 12 hours in children and every 24 hours in most adults, making it a convenient option for treatment 3.
• A study comparing ceftriaxone to cefazolin found that ceftriaxone was effective in treating skin and soft tissue infections, including cellulitis, with minimal side effects 4.
• Ceftriaxone has been shown to be effective in treating infections caused by staphylococci and streptococci, which are common causes of cellulitis 3, 4.

Efficacy and Safety of Ceftriaxone

• Ceftriaxone has been found to be effective in treating cellulitis, with clinical cure rates of 81% in one study 4.
• The drug has been shown to be safe, with minimal side effects reported in clinical trials 3, 4.
• Ceftriaxone's efficacy and safety make it a suitable option for the treatment of cellulitis, particularly in cases where the infection is caused by susceptible organisms 3, 4.

Comparison to Other Treatments

• Ceftriaxone has been compared to other antibiotics, such as cefazolin and vancomycin, and has been found to be effective in treating cellulitis 4, 5.
• The choice of antibiotic treatment for cellulitis depends on the severity of the infection, the causative organism, and the patient's medical history 6, 7.
• Ceftriaxone may be considered as an option for the treatment of cellulitis, particularly in cases where the infection is severe or the patient has a history of allergy to other antibiotics 3, 4.