From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
The best antibiotic for cellulitis is typically trimethoprim-sulfamethoxazole at a dose of 1-2 double-strength tablets twice daily for 5-10 days, as it has been shown to have a higher treatment success rate compared to cephalexin, especially in areas with a high prevalence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections 1.
Key Considerations
- For patients with mild to moderate cellulitis without complicating factors, trimethoprim-sulfamethoxazole effectively targets the most common causative organisms: Streptococcus and Staphylococcus species.
- Alternatives for penicillin-allergic patients include clindamycin (300-450 mg orally four times daily) or doxycycline (100 mg twice daily) if MRSA is suspected.
- More severe cases may require intravenous antibiotics like cefazolin or vancomycin.
- Treatment should be adjusted based on clinical response within 48-72 hours, and patients should elevate the affected area, apply warm compresses, and seek immediate medical attention if they develop fever, increasing pain, rapid spread of redness, or other signs of worsening infection.
- The choice of antibiotic may need adjustment based on local resistance patterns, patient allergies, and specific risk factors.
Recent Evidence
- A 2020 study found that the route of antibiotic administration (oral vs intravenous) and duration of treatment did not significantly impact clinical outcome in patients with cellulitis 2.
- A 2019 systematic review and meta-analysis found that there is low-quality evidence to support the superiority of any one antibiotic over another, and that antibiotics with activity against MRSA did not add an advantage 3.
- A 2022 review of current practice guidelines for cellulitis highlights the importance of considering local resistance patterns and patient-specific factors when selecting an antibiotic, and notes that trimethoprim-sulfamethoxazole is a suitable option for empiric treatment in many cases 4.