From the Guidelines
Uncomplicated cellulitis is a common bacterial skin infection that affects the deeper layers of the skin and underlying tissue, characterized by redness, swelling, warmth, and pain in the affected area, and is typically treated with oral antibiotics such as cephalexin, dicloxacillin, or clindamycin for 5 days, as supported by the most recent guidelines 1.
Key Characteristics of Uncomplicated Cellulitis
- It typically occurs when bacteria enter through a break in the skin such as a cut, scrape, or insect bite.
- The infection is usually caused by streptococci, often group A, but also from other groups, such as B, C, or G, as indicated by culture results and serologic studies 1.
- Uncomplicated cellulitis differs from complicated cases in that it doesn't involve deeper tissues, doesn't occur in immunocompromised patients, and doesn't affect critical areas like the face, hands, or genitals.
Treatment and Management
- Treatment usually involves oral antibiotics such as cephalexin 500mg four times daily, dicloxacillin 500mg four times daily, or clindamycin 300-450mg three times daily for 5 days, depending on severity and response, as recommended by the Infectious Diseases Society of America 1.
- For mild to moderate cases, empiric coverage for Streptococcus and Staphylococcus aureus is appropriate.
- In addition to antibiotics, patients should elevate the affected limb to reduce swelling, apply warm compresses, take over-the-counter pain relievers like acetaminophen or ibuprofen as needed, and rest until symptoms improve.
- Patients should seek immediate medical attention if they develop fever, increasing pain, spreading redness, or red streaks extending from the infected area, as these may indicate worsening infection.
Prevention of Recurrence
- Measures to reduce recurrences of cellulitis include treating interdigital maceration, keeping the skin well hydrated with emollients to avoid dryness and cracking, and reducing any underlying edema by such methods as elevation of the extremity, compressive stockings or pneumatic pressure pumps, and, if appropriate, diuretic therapy, as suggested by the guidelines 1.
- Prophylactic antibiotics may be considered for patients with frequent infections, with options including monthly intramuscular benzathine penicillin injections or oral therapy with twice-daily doses of either 250 mg of erythromycin or 1 g of penicillin V 1.
From the Research
Definition of Uncomplicated Cellulitis
Uncomplicated cellulitis is a type of skin infection that does not have any purulent drainage, wound, or abscess 2. It is characterized by the presence of erythema, swelling, and tenderness, and is often caused by β-hemolytic streptococci or other bacteria.
Clinical Presentation
The clinical presentation of uncomplicated cellulitis includes:
- Erythema (redness) and swelling of the affected area
- Tenderness to the touch
- Fever
- Pain
- Increased warmth of the affected area
Treatment
The treatment of uncomplicated cellulitis typically involves the use of antibiotics, such as:
- Cephalexin
- Trimethoprim-sulfamethoxazole
- Clindamycin
- Azithromycin
- Cefaclor
The choice of antibiotic depends on the severity of the infection, the presence of any underlying medical conditions, and the likelihood of resistance to certain antibiotics 3, 4, 5, 6.
Key Findings
Some key findings from the studies include:
- The use of cephalexin plus trimethoprim-sulfamethoxazole did not result in higher rates of clinical resolution of cellulitis compared to cephalexin alone 2
- The mean time to clinical response was 1.68 days, with a significant reduction in pain and severity score by day 5, and a reduction in area of redness and edema by day 2-4 3
- Trimethoprim-sulfamethoxazole had a higher treatment success rate compared to cephalexin, especially in patients with community-associated MRSA infections 4
- There was no significant difference in clinical failure between beta-lactam and non-beta-lactam antibiotics for the treatment of uncomplicated cellulitis 5
- A network meta-analysis found no significant differences in cure rates among antibiotics for cellulitis, but ceftriaxone had the fewest gastrointestinal side effects 6