What is the management of facial cellulitis (infection of the skin and subcutaneous tissues) of the cheek?

From the Guidelines

The management of cellulitis of the cheek should primarily involve antimicrobial agents active against streptococci, with consideration for coverage against MSSA or MRSA in certain cases, and supportive care including elevation of the affected area and treatment of predisposing factors. When considering the management of cellulitis of the cheek, it's crucial to differentiate between typical cases without systemic signs of infection and those with systemic signs or severe infection. For typical cases, antimicrobial agents active against streptococci are recommended 1. The choice of antibiotic should be based on the severity of the infection and the presence of risk factors for resistant organisms such as MRSA. Key considerations include:

• The use of cultures or other diagnostic tests is not routinely recommended but may be considered in specific patient populations such as those with malignancy, neutropenia, or severe immunodeficiency 1.
• The recommended duration of antimicrobial therapy is typically 5 days but may need to be extended if there's no improvement within this timeframe 1.
• Supportive care measures such as elevation of the affected area and treatment of predisposing factors like edema are also important 1.
• Outpatient therapy can be considered for patients without systemic signs of infection or other complicating factors, while hospitalization may be necessary for more severe cases or those at high risk of complications 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 Serious skin and soft tissue infections. The management of cellulitis of the cheek may involve the use of antibiotics such as cephalexin (2) or clindamycin (3), as both drugs are indicated for the treatment of skin and skin structure infections caused by susceptible strains of microorganisms, including Staphylococcus aureus and Streptococcus pyogenes.

• The choice of antibiotic should be based on culture and susceptibility tests when available.
• In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

From the Research

Management of Cellulitis of the Cheek

• The management of cellulitis, including cellulitis of the cheek, 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, 6, 7, 8.
• For uncomplicated cellulitis, antibiotics such as penicillin, amoxicillin, and cephalexin are commonly used, as they provide coverage against β-hemolytic streptococci and methicillin-sensitive Staphylococcus aureus, which are the most common causes of cellulitis 4, 5, 7.
• 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 6, 7.
• The use of antibiotics with MRSA activity, such as trimethoprim-sulfamethoxazole, in addition to cephalexin, has been studied, and the results have been mixed, with some studies showing no significant difference in clinical cure rates between the two groups 5, 7.
• The diagnosis of cellulitis is typically based on clinical presentation, including symptoms such as redness, warmth, swelling, and tenderness, and physical examination, and may be aided by point-of-care ultrasound in unclear cases 8.
• Treatment for cellulitis typically involves oral antibiotics, and most patients can be managed as outpatients, although hospitalization may be necessary in severe cases or in patients with underlying medical conditions 4, 8.