What is the duration of vancomycin treatment for cellulitis?

From the Guidelines

Vancomycin treatment for cellulitis should typically last 5-7 days, but the duration may be extended if the infection has not improved within this time period.

Key Considerations

• The Infectious Diseases Society of America (IDSA) recommends a 5-day course of antimicrobial therapy for cellulitis, with extension of treatment if the infection has not improved within this time period 1.
• The duration of therapy should be individualized based on the patient's clinical response, as noted in the guidelines for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections 1.
• A 5- to 6-day course of antibiotics active against streptococci is recommended for patients with nonpurulent cellulitis, particularly for those able to self-monitor and who have close follow-up with primary care 1.

Important Details

• Vancomycin is recommended for patients with cellulitis associated with penetrating trauma, evidence of MRSA infection elsewhere, nasal colonization with MRSA, injection drug use, or systemic inflammatory response syndrome (SIRS) 1.
• The choice of antibiotic and duration of therapy should be guided by the severity of the infection, the presence of underlying medical conditions, and the patient's clinical response to treatment 1.

From the FDA Drug Label

The mean duration of treatment was 9. 4 days.

The duration of vancomycin treatment is 9.4 days on average, but this information is for the treatment of diarrhea associated with C. difficile, not cellulitis. No conclusion can be drawn for the treatment of cellulitis. 2

From the Research

Duration of Vancomycin Treatment for Cellulitis

• The duration of vancomycin treatment for cellulitis can vary, but according to a study published in 2009 3, vancomycin was administered for 7-14 days.
• Another study published in 2018 4 found that the recommended duration of antibiotic therapy for patients hospitalized with cellulitis is 5-14 days.
• A study from 2004 5 compared a short-course (5 days) and standard (10 days) treatment for uncomplicated cellulitis and found no significant difference in clinical outcome between the two courses of therapy.
• A protocol for a randomized controlled trial published in 2014 6 compared short to standard duration of antibiotic therapy for patients hospitalized with cellulitis, with the short duration being 6 days and the standard duration being 12 days.
• A study published in 2020 7 found no association between the duration of antibiotic therapy and outcome as measured at day 10 and day 30, suggesting that a shorter course of treatment may be effective.

Factors Affecting Treatment Duration

• Patient age, C-reactive protein levels, coexisting diabetes mellitus, and coexisting blood stream infection were found to be associated with longer treatment duration in a study published in 2018 4.
• The severity of cellulitis, as measured by C-reactive protein levels and affected skin surface area, was found to be associated with the route of antibiotic administration, with more severe cases being more likely to receive intravenous therapy 7.