From the Guidelines
Foot cellulitis requires prompt antibiotic treatment, and for typical cases without systemic signs of infection, an antimicrobial agent active against streptococci is recommended. The treatment should be based on the severity of the infection and the patient's overall health status. According to the guidelines from the Infectious Diseases Society of America 1, typical cases of cellulitis without systemic signs of infection should receive an antimicrobial agent that is active against streptococci.
Treatment Options
- For mild to moderate foot cellulitis, oral antibiotics such as cephalexin or clindamycin are typically effective.
- Severe cases may require intravenous antibiotics like ceftriaxone or vancomycin.
- The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period 1.
Management
- Elevate the affected foot above heart level when possible to reduce swelling.
- Apply warm compresses several times daily to help reduce pain and discomfort.
- Take over-the-counter pain relievers like acetaminophen or ibuprofen as needed for discomfort.
- Monitor for signs of worsening infection, such as spreading redness, increasing pain, fever, or streaking up the leg, which would require immediate medical attention.
High-Risk Patients
- People with diabetes, poor circulation, or compromised immune systems are at higher risk and should seek medical attention promptly to prevent complications like tissue damage or bloodstream infection.
- In severely compromised patients, broad-spectrum antimicrobial coverage may be considered, and vancomycin plus either piperacillin-tazobactam or imipenem/meropenem is recommended as a reasonable empiric regimen for severe infections 1.
From the FDA Drug Label
Skin and skin structure infections caused by Staphylococcus aureus and/or Streptococcus pyogenes Serious skin and soft tissue infections; septicemia; intra- abdominal infections such as peritonitis and intra-abdominal abscess; infections of the female pelvis and genital tract such as endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection.
Foot cellulitis is a type of skin and skin structure infection.
- Cephalexin 2 is indicated for the treatment of skin and skin structure infections caused by Staphylococcus aureus and/or Streptococcus pyogenes.
- Clindamycin 3 is indicated for the treatment of serious skin and soft tissue infections, including pelvic cellulitis. However, foot cellulitis is not explicitly mentioned in either drug label. Therefore, no conclusion can be drawn about the use of these medications for foot cellulitis.
From the Research
Foot Cellulitis Treatment
- The treatment of foot cellulitis typically involves the use of antibiotics, with the choice of antibiotic depending on the suspected causative organism and the severity of the infection 4, 5.
- For uncomplicated cellulitis, antibiotics such as penicillin, amoxicillin, and cephalexin are often used, as they are effective against β-hemolytic streptococci, which are commonly implicated in these infections 5.
- However, in areas with a high prevalence of community-associated methicillin-resistant Staphylococcus aureus (MRSA), antibiotics with activity against MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, may be preferred 4.
- Studies have shown that the addition of trimethoprim-sulfamethoxazole to cephalexin does not significantly improve outcomes in patients with uncomplicated cellulitis, suggesting that MRSA coverage may not be necessary in these cases 6, 7.
Antibiotic Choice
- Cephalexin is a commonly used antibiotic for the treatment of cellulitis, but its effectiveness may be limited in areas with high rates of MRSA 4.
- Trimethoprim-sulfamethoxazole and clindamycin are alternative antibiotics that have activity against MRSA and may be preferred in certain cases 4, 5.
- The choice of antibiotic should be based on the severity of the infection, the suspected causative organism, and the patient's medical history and allergies 5.
Clinical Trials
- A randomized controlled trial found that the addition of trimethoprim-sulfamethoxazole to cephalexin did not improve outcomes in patients with uncomplicated cellulitis 6.
- Another study found that the use of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone did not result in higher rates of clinical resolution of cellulitis in the per-protocol analysis 7.
- A review of the literature suggests that empirical coverage of CA-MRSA is not necessary for the treatment of nonpurulent cellulitis, and that antibiotics targeting β-hemolytic streptococci are sufficient 8.