From the FDA Drug Label
Complicated Skin and Skin Structure Infections Adult patients with clinically documented complicated skin and skin structure infections were enrolled in a randomized, multi-center, double-blind, double-dummy trial comparing study medications administered IV followed by medications given orally for a total of 10 to 21 days of treatment. The cure rates in clinically evaluable patients were 90% in linezolid-treated patients and 85% in oxacillin-treated patients
The best antibiotic for leg cellulitis is linezolid, with a cure rate of 90% in clinically evaluable patients, as compared to 85% for oxacillin-treated patients 1.
- Key points:
- Linezolid is effective against complicated skin and skin structure infections, including those caused by Staphylococcus aureus and Streptococcus pyogenes.
- The cure rates for linezolid-treated patients were higher than those for oxacillin-treated patients.
- Linezolid may be a suitable option for the treatment of leg cellulitis, particularly in cases where the infection is caused by Gram-positive bacteria.
From the Research
For leg cellulitis, the most effective antibiotic treatment is cefaclor, as it demonstrates the most favorable profile for curative outcomes, according to the most recent and highest quality study 2.
Key Considerations
- The choice of antibiotic should be based on the suspected causative organisms, with Staphylococcus aureus and Streptococcus species being the most common.
- The study by 2 found no significant differences in cure rates among antibiotics for cellulitis, but cefaclor showed the most promising results.
- For erysipelas, pristinamycin showed the highest cure rates, but with a higher risk of rash.
- Ceftriaxone had the fewest gastrointestinal side effects among the antibiotics analyzed.
Treatment Options
- Cefaclor: 250-500 mg taken orally three times daily for 5-10 days, depending on severity.
- Alternative options: cephalexin 500 mg taken orally four times daily, dicloxacillin 500 mg four times daily, or clindamycin 300-450 mg three times daily.
- For more severe cases requiring intravenous therapy, cefazolin 1-2 g every 8 hours or oxacillin 1-2 g every 4-6 hours may be necessary.
Important Notes
- If MRSA is suspected based on risk factors or local prevalence, consider trimethoprim-sulfamethoxazole (Bactrim) 1-2 double-strength tablets twice daily or doxycycline 100 mg twice daily.
- Elevate the affected limb, apply warm compresses, and monitor for spreading redness, fever, or increasing pain, which may indicate worsening infection requiring medical reassessment.
- Complete the full course of antibiotics even if symptoms improve quickly to prevent recurrence or antibiotic resistance.