The best evidence right now is that for simple cellulitis (no purulence, abscess, or exudate), treatment with a beta-lactam antibiotic is the best option. There is no need to add MRSA coverage to beta-lactam therapy. If there is no response to treatment, then broadening coverage to include MRSA would be appropriate.
Full Answer
Is there a role for MRSA in cellulitis without abscess or drainage?
The role of MRSA in cellulitis without abscess or purulent drainage is less clear since cultures are rarely obtained. Outpatient management of SSTIs in the era of community-associated MRSA.
How do you treat a mild MRSA infection?
Empiric: IV from above or oral from below. MRSA: IV from above or oral from below. Mild: no culture required, use oral options from above. Erysipelas: consider prednisone 30mg with taper over 8 days to assist with inflammatory reaction (may want to avoid in diabetes).
Which parenteral antibiotics are used in the treatment of MRSA infection?
In more severe cases that require parenteral antibiotics to cover MRSA, vancomycin, daptomycin, tigecycline, ceftaroline, and linezolid are appropriate choices. Data are more limited for the newer agents, but they have been shown to have similar efficacy to vancomycin in some clinical trials. [ 74]
What are the recommendations for the treatment of cellulitis?
While recommendations regarding specific antimicrobial agents will vary depending on local practice and resistance rates, suggested empiric regimens are outlined in Table 2. Patients with mild to moderate cellulitis should be treated with an agent active against streptococci.
What is the treatment for mild cellulitis?
For mild cellulitis affecting a small area of skin, a doctor will prescribe antibiotic tablets – usually for a week. Your symptoms might get worse in the first 48 hours of treatment, but should then start to improve. Contact a GP if you do not start to feel better 2 to 3 days after starting antibiotics.
Which drug is the first choice for MRSA coverage in cellulitis?
Pathogen Specific TherapyPathogenFirst-Line AgentGroup A StreptococciPenicillinStaphylococcus aureus (methicillin-sensitive)Dicloxacillin Oxacillin, nafcillin Cephalexin, cefuroxime, cefazolin, cefadroxil, ceftriaxoneStaphylococcus aureus (methicillin-resistant)Vancomycin5 more rows•Jan 1, 2019
What is the first choice antibiotic for cellulitis?
Therefore, the principal antibiotics recommended for treating cellulitis are first-generation cephalosporins, such as cefazolin, and penicillinase-resistant penicillin, such as nafcillin, which are effective against S. aureus and streptococci [3,4].
How do you treat uncomplicated cellulitis?
Uncomplicated Cellulitis Most cases of cellulitis can be treated with 5–7 days of antibiotics. This recommendation is supported by evidence from clinical trials showing that shorter course therapy is as effective as longer courses. For example, a randomized controlled trial compared 5 versus 10 days of therapy.
What antibiotics treat cellulitis MRSA?
At home — Treatment of MRSA at home usually includes a 7- to 10-day course of an antibiotic (by mouth) such as trimethoprim-sulfamethoxazole (brand name: Bactrim), clindamycin, minocycline, linezolid, or doxycycline.
What are the first two antibiotics used for an MRSA infection?
Some antibiotics available in oral formulations are treatment options for MRSA:First-line therapy: trimethoprim-sulfamethoxazole (TMP-SMX; Bactrim DS, Septra DS. ... Second-line therapy: clindamycin (Cleocin). ... Third-line therapy: tetracycline or doxycycline/minocycline (Dynacin, Minocin). ... Fourth-line therapy: linezolid.More items...•
Does cephalexin 500mg treat cellulitis?
Cellulitis is most commonly treated with the oral antibiotic cephalexin.
Does Keflex and Bactrim treat MRSA?
Bactrim (sulfamethoxazole and trimethoprim) DS is a combination of two antibiotics used to treat urinary tract infections, acute otitis media, bronchitis, Shigellosis, Pneumocystis pneumonia, traveler's diarrhea, methicillin-resistant Staphylococcus aureus (MRSA), and other bacterial infections susceptible to this ...
What is the most effective antibiotic for cellulitis?
The best antibiotic to treat cellulitis include dicloxacillin, cephalexin, trimethoprim with sulfamethoxazole, clindamycin, or doxycycline antibiotics.
What is non purulent cellulitis?
Non-purulent cellulitis was defined as cellulitis without purulent drainage or exudate or associated abscess [15]. CA-MRSA was defined as MRSA isolated from a patient who had none of the following established risk factors for HA-MRSA.
Does cellulitis always require antibiotics?
Without antibiotic treatment, cellulitis can spread beyond the skin. It can enter your lymph nodes and spread into your bloodstream. Once it reaches your bloodstream, bacteria can cause quickly cause a life-threatening infection known as blood poisoning. Without proper treatment, cellulitis can also return.
Is Keflex a good antibiotic for cellulitis?
As most cases of uncomplicated cellulitis are caused by Strep, they are still best treated with a penicillin or cephalosporin (e.g., Keflex) type of antibiotic, known as beta-lactams. These antibiotics are much better than TMP-SMX for strep infections. These drugs are also safer than clindamycin, for widespread use.
What are some alternatives to anti-MRSA?
Additional alternative anti-MRSA agents include ceftaroline, linezolid, tedizolid, delafloxacin, omadacycline, telavancin, dalbavancin, and oritavancin; use of these agents is limited by high cost and, in some cases, availability.
When is parenteral antimicrobial therapy appropriate?
Parenteral antimicrobial therapy is generally appropriate when severe illness or any of these features is present. Comorbidities that increase the risk of severe or complicated infection, such as the presence of an immunocompromising condition (eg, neutropenia, recent organ transplant, advanced HIV infection, B cell or T cell deficiency, ...
What are some alternatives to penicillin?
For patients with a penicillin allergy, cephalexin (depending on the allergy), clindamycin, and trimethoprim-sulfamethoxazole are alternatives. Linezolid is another alternative but should be reserved for circumstances in which the other options cannot be used. ¥ Risk factors for MRSA include:
Can you take minocycline with amoxicillin?
However, doxycycline and minocycline do not have good antistreptococcal activity and so are administered with amoxicillin. Other active options include linezolid, tedizolid, and delafloxacin, but these should be reserved for circumstances in which the other options cannot be used.
How long does it take for MRSA to develop?
It is important to discuss a follow-up plan with your patients in case they develop systemic symptoms or worsening local symptoms, or if symptoms do not improve within 48 hours.
What is the purpose of obtaining specimens for culture and susceptibility testing?
Obtaining specimens for culture and susceptibility testing is useful to guide therapy , particularly for those with more severe infections and those who fail to respond adequately to initial management.
Is a spider bite a S. aureus infection?
A patient’s presenting complaint of “spider bite” should raise suspicion of an S. aureus infection. Recent data suggest that MRSA as a cause of skin infections in the general community remains at high probability.
Is incision and drainage the primary treatment for MRSA?
In the community, incision and drainage remains the primary therapy for these purulent skin infections. Empiric antibiotic coverage for MRSA may be warranted in addition to incision and drainage based on clinical assessment (e.g., presence of systemic symptoms, severe local symptoms, immune suppression, extremes of patient age, infections in a difficult to drain area, or lack of response to incision and drainage alone).
How long can cellulitis be treated?
Comment: Randomized trial for 5 vs 10 days of treatment showed uncomplicated cellulitis could be treated for 5 days.
Who wrote the systematic review of bacteremias in cellulitis and erysipelas?
Gunderson CG, Martinello RA. A systematic review of bacteremias in cellulitis and erysipelas. J Infect. 2011. [PMID:22101078]
How many cases of cellulitis fail?
Comment: Cellulitis failure rates according to literature review vary widely (6-37%). The author speculates that this reflects many cases that simply mimic cellulitis.
How many cases of dermatologic surgery were antibiotics used?
Comment: Clean dermatologic surgery database was reviewed for use of topical antibiotics. Topical antibiotics were used in 8 million of 212 million cases (5%), which the authors considered inappropriate use. Note that this reiew was selected because of the useless but sometimes common practice of using topical antibiotics on clean wounds.
What is the most common form of cellulitis?
Most common form of cellulitis: leg (tibial area) with breach in skin usually due to intertrigo.
Is orbital cellulitis serious?
Orbital cellulitis is potentially serious and merits an ophthalmology consultation and a CT scan to exclude preseptal infection.
Is cellulitis a subcutaneous disease?
Cellulitis: deeper (subcutaneous) than erysipelas. Also usually group A Streptococcus, but other streptococci occasionally implicated, e.g., group G.
Why do we never know the cause of cellulitis?
Unlike with abscesses, we almost never know the cause of cellulitis because there’s nothing to culture. Studies have tried unsuccessfully to use conventional cultures of skin biopsies. You may recall being directed as an intern to aspirate the leading edge. All for naught.
Can you treat cellulitis with penicillin?
Infectious Diseases Society of America (IDSA) treatment guidelines state that uncomplicated cellulitis can be treated with just penicillin, providing fodder for yet another target for ED antibiotic-overuse shaming.
Can cellulitis be cultured?
Unlike with abscesses, we almost never know the cause of cellulitis because there’s nothing to culture. Studies have tried unsuccessfully to use conventional cultures of skin biopsies. You may recall being directed as an intern to aspirate the leading edge. All for naught. Serological studies have suggested -strep, but these tests might yield false positives. Rarely, a blood culture kicks out a strep or staph, but these cases hardly reflect usual circumstances. Our group even tried to unlock this mystery by comparing polymerase chain reaction and pyrosequencing results from skin biopsies of the infected and opposite limb uninfected site with no luck. 1
Does trimethoprim cover cellulitis?
So it’s logical that MRSA coverage would lead to better outcomes for cellulitis.
Does MRSA help cellulitis?
This suggested that MRSA plays a role in some cellulitis cases, but overall, adding an antibiotic with MRSA activity did not improve outcomes. Table 1: Effectiveness of Adding a MRSA-Targeting Antibiotic to Cellulitis Treatment.
What is mild cellulitis?
Mild cellulitis with a fine lacelike pattern of erythema. This lesion was only slightly warm and caused minimal pain, which is typical for the initial presentation of mild cellulitis.
What medicine to take for methicillin resistant S aureus?
Dicloxacillin, cephalexin. Add trimethoprim/ sulfamethoxazole or tetracycline or clindamycin if concern for methicillin-resistant S aureus
What is the best treatment for tinea pedis?
If tinea pedis is considered a possible cause of recurrent cellulitis episodes, treatment with a topical antifungal is recommended. Oral antifungals, such as itraconazole or terbinafine, may be considered in cases of refractory chronic changes or if onychomycosis is providing a source for repeated infection.
What are the common recurrent episodes of tinea pedis?
Recurrent episodes common; may be associated with rigors, extreme fatigue, myalgias, and hypotension; some associated with tinea pedis (toe web cultures may be useful in establishing probable pathogen)
Is vancomycin a parenteral antibiotic?
In more severe cases that require parenteral antibiotics to cover MRSA, vancomycin, daptomycin, tigecycline, ceftaroline, and linezolid are appropriate choices. Data are more limited for the newer agents, but they have been shown to have similar efficacy to vancomycin in some clinical trials. [ 74] Daptomycin has been associated with more rapid resolution of signs and symptoms of cellulitis in some trials. [ 75, 76] However, vancomycin continues to be the drug of choice because of its overall excellent tolerability profile, efficacy, and cost. [ 74]
Which bacterial pathogens produce rapidly progressive soft tissue infection and sepsis?
A hydrophila and Vibrio vulnificus may produce rapidly progressive soft-tissue infection and sepsis
Is vancomycin good for cellulitis?
[ 75, 76] However, vancomycin continues to be the drug of choice because of its overall excellent tolerability profile, efficacy, and cost.