From the Guidelines
For patients with nonpurulent cellulitis, a 5- to 6-day course of antibiotics active against streptococci is recommended, particularly for patients able to self-monitor and who have close follow-up with primary care. This recommendation is based on the most recent and highest quality study available, which suggests that a shorter course of antibiotics can be effective in treating nonpurulent cellulitis 1. The study found that a 5- to 6-day course of antibiotics was sufficient for patients with nonpurulent cellulitis, and that extending treatment beyond this period did not provide additional benefits.
Some key points to consider when treating skin infections include:
- The type and severity of the infection, as well as the patient's overall health and ability to self-monitor and follow up with primary care
- The use of antibiotics active against streptococci, such as cephalosporins, penicillins, or clindamycin
- The importance of completing the full prescribed course of antibiotics, even if symptoms improve early, to prevent recurrence and antibiotic resistance
- The need for medical reevaluation if symptoms worsen after 48 hours of treatment or do not improve within 3 days
It's also worth noting that other studies have suggested similar treatment durations for skin infections, including a 2014 study that recommended a 5-day course of antibiotics for uncomplicated cellulitis 1, and a 2005 study that found that 5 days of antibiotic treatment was as effective as a 10-day course for uncomplicated cellulitis 1. However, the most recent and highest quality study available supports the use of a 5- to 6-day course of antibiotics for nonpurulent cellulitis.
From the FDA Drug Label
For the following infections, a dosage of 500 mg may be administered every 12 hours: streptococcal pharyngitis, skin and skin structure infections, and uncomplicated cystitis in patients over 15 years of age. The length of treatment for skin infection is not explicitly stated in the provided drug label, except that it mentions the dosage for skin and skin structure infections. However, it does mention that cystitis therapy should be continued for 7 to 14 days, but this is for a different type of infection.
- The dosage for skin and skin structure infections is 500 mg every 12 hours. Since the label does not provide a specific duration for skin infection treatment, no conclusion can be drawn 2.
From the Research
Length of Treatment for Skin Infection
- The length of treatment for skin infections can vary depending on the type and severity of the infection, as well as the antibiotic used 3.
- For uncomplicated skin and skin structure infections (uSSSIs), treatment is typically given for 7-10 days 4, 5.
- A study comparing cefdinir and cephalexin for mild to moderate uSSSIs found that both treatments were effective for 10 days 4.
- Another study found that cephalexin given twice daily was effective for the treatment of staphylococcal skin and skin structure infections, with treatment lasting around 7-10 days 5.
- For impetigo, treatment typically lasts for 7-10 days, with topical antibiotics such as mupirocin, retapamulin, and fusidic acid being effective for nonbullous impetigo, and oral antibiotic therapy being used for impetigo with large bullae or when topical therapy is impractical 6.
Factors Affecting Treatment Length
- The type of bacteria causing the infection can affect the length of treatment, with methicillin-resistant Staphylococcus aureus (MRSA) infections potentially requiring longer treatment durations 3, 6.
- The severity of the infection can also impact treatment length, with more severe infections requiring longer treatment durations 4, 5.
- Patient compliance with antibiotic treatment can also affect the length of treatment, with twice-daily dosing regimens potentially enhancing compliance 5, 7.