From the Guidelines
The appropriate dose and frequency for treating cellulitis is typically a 5- to 6-day course of antibiotics active against streptococci, such as penicillin, amoxicillin, or clindamycin, with the specific antibiotic and duration of treatment depending on the severity of the infection and the patient's individual needs 1.
Key Considerations
- The choice of antibiotic should be based on the severity of the infection and the patient's individual needs, with consideration of factors such as the presence of systemic signs of infection, immunocompromised status, and potential for MRSA infection 1.
- For 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.
- The recommended duration of antimicrobial therapy can be extended if the infection has not improved within the initial treatment period, with treatment typically lasting 5-14 days depending on the severity of the infection and the patient's response to treatment 1.
Antibiotic Options
- For patients with nonpurulent cellulitis, empirical therapy for infection due to beta-hemolytic streptococci is recommended, with options including penicillin, amoxicillin, or clindamycin 1.
- For patients with purulent cellulitis or those who do not respond to beta-lactam therapy, empirical coverage for CA-MRSA is recommended, with options including clindamycin, TMP-SMX, or a tetracycline 1.
- For hospitalized patients with complicated SSTI, empirical therapy for MRSA should be considered pending culture data, with options including IV vancomycin, linezolid, or daptomycin 1.
From the Research
Treatment of Cellulitis
The treatment of cellulitis typically involves the use of antibiotics, with the goal of covering the most likely causative organisms, such as Streptococcus and methicillin-sensitive Staphylococcus aureus 2, 3. The choice of antibiotic and duration of treatment may vary depending on the severity of the infection and the presence of any underlying medical conditions.
Antibiotic Regimens
- For uncomplicated cellulitis, oral antibiotics such as penicillin, amoxicillin, and cephalexin are often sufficient 3.
- In cases where methicillin-resistant Staphylococcus aureus (MRSA) is suspected, broader-spectrum antibiotics may be necessary 2.
- The duration of treatment is typically 5 days, but may be extended if symptoms persist 2.
Special Considerations
- In regions where community-acquired MRSA is infrequent, oxacillin or cefalotin may be effective treatment options for uncomplicated cellulitis 4.
- Patients with frequent recurrences of cellulitis may benefit from antimicrobial prophylaxis 5.
- It is essential to address predisposing factors, such as chronic edema or tinea pedis, to minimize the risk of recurrence 5, 6.
Diagnostic Considerations
- Cellulitis is a clinical diagnosis, based on history and physical examination, and lacks a gold standard for diagnosis 3.
- Imaging studies may be helpful in some cases, but are not always necessary 5.
- Non-infectious causes of local symptoms, such as lymphedema or venous stasis, should be considered in the differential diagnosis 6.