In mild cases of cellulitis treated on an outpatient basis, dicloxacillin, amoxicillin, and cephalexin are all reasonable choices. Clindamycin or a macrolide (clarithromycin or azithromycin) are reasonable alternatives in patients who are allergic to penicillin.
Full Answer
What is included in the management of cellulitis?
Management should include limb elevation and continuing narrow-spectrum antimicrobial therapy alongside treatment of comorbid conditions exacerbating the cellulitis (oedema, diabetes, vascular disease)
Can uncomplicated cellulitis be treated for 5 days?
Comment: Randomized trial for 5 vs 10 days of treatment showed uncomplicated cellulitis could be treated for 5 days. Cellulitis is a sample topic from the Johns Hopkins ABX Guide. To view other topics, please log in or purchase a subscription.
What are the treatment options for nonpurulent cellulitis (eczema)?
(See 'Oral versus parenteral therapy'above.) ●The management of patients with nonpurulent infection (ie, cellulitis or erysipelas in the absence of abscess or purulent drainage) consists of antibiotic therapy (algorithm 1).
When are suppressive antibiotics indicated in the treatment of cellulitis?
Suppressive antibiotic therapy may be warranted for patients with three to four episodes of cellulitis per year in the setting of predisposing factors that cannot be alleviated, for as long as the predisposing factors persist [2].
How long does it take for cellulitis to heal?
What is nonpurulent skin infection?
How long does oral therapy for MRSA last?
Is UpToDate a substitute for medical advice?
Does antimicrobial treatment help with abscess?
Can corticosteroids be used for cellulitis?
Is purulence a secondary infection?
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What is the standard treatment for cellulitis?
Usually, cellulitis is presumed to be due to staphylococci or streptococci infection and may be treated with cefazolin, cefuroxime, ceftriaxone, nafcillin, or oxacillin. Antimicrobial options in patients who are allergic to penicillin include clindamycin or vancomycin.
What is the most common treatment for cellulitis?
Cellulitis treatment usually includes a prescription oral antibiotic. Within three days of starting an antibiotic, let your health care provider know whether the infection is responding to treatment. You'll need to take the antibiotic for the full course, usually 5 to 10 days, even if you start to feel better.
What is the first line treatment 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].
What is uncomplicated cellulitis?
Uncomplicated SSTIs include superficial cellulitis, folliculitis, furunculosis, simple abscesses, and minor wound infections. These infections respond well to either source control management (ie, drainage or debridement) or a simple course of antibiotics. These infections pose little risk to life and limb.
What is cellulitis and treatment?
Cellulitis is a bacterial infection of your skin and the tissue beneath your skin. Anyone can get cellulitis, but the risk is higher if you have a skin wound that allows bacteria to enter your body easily or a weakened immune system. Treatment includes antibiotics.
What IV antibiotics are used for cellulitis?
In the United States, many clinicians elect to cover for MSSA using IV cefazolin or ampicillin/sulbactam, or an oral first- generation cephalosporin or amoxicillin/clavulanate. Purulent cellulitis is primarily caused by S. aureus, including MRSA.
Do you need IV antibiotics for cellulitis?
Those with moderate or severe nonpurulent cellulitis that have systemic signs of infection should receive IV antibiotics (1). Diabetics, while at increased risk for infections, are not considered immunocompromised in these guidelines, and there are separate guidelines for diabetic foot infections.
What are first generation cephalosporins?
First-generation cephalosporins act on all gram-positive bacteria such as staphylococci and streptococci and show little activity against gram-negative bacteria. First-generation cephalosporins inhibit bacterial cell wall synthesis and have the same mode of action as other beta-lactam antibiotics (such as penicillins).
Is vancomycin used to treat cellulitis?
Vancomycin is the Drug of Choice for Treating Cellulitis.
What is an uncomplicated skin infection?
Uncomplicated SSTIs include superficial cellulitis, folliculitis, furunculosis, simple abscesses, and minor wound infections. These infections respond well to either source control management (ie, drainage or debridement) or a simple course of antibiotics. These infections pose little risk to life and limb.
Why is Flucloxacillin first line for cellulitis?
Flucloxacillin has traditionally been the first-line oral antibiotic for patients with cellulitis because all S. pyogenes and other related streptococci are susceptible to treatment with flucloxacillin, as are approximately 90% of strains of S. aureus (i.e. all S.
What is Keflex used for?
This medication is used to treat a wide variety of bacterial infections. This medication is known as a cephalosporin antibiotic. It works by stopping the growth of bacteria. This medication will not work for viral infections (such as common cold, flu).
Guidelines for Treatment of Skin and Soft Tissue Infections
Guidelines for Treatment of Skin and Soft Tissue Infections – continued. Bite wounds Human: S. viridans, S. aureus, Haemophilus . spp., Eikenella corrodens,
Cellulitis Treatment Guidelines - AFMC
Cellulitis Treatment Guidelines Nonpurulent Cellulitis (eg, cellulitis with no purulent drainage or exudate and no associated abscess) Organisms: beta-hemolytic streptococci and MSSA.
EMPIRIC ANTIBIOTIC GUIDELINES FOR SKIN AND SOFT TISSUE INFECTIONS IN ...
EMPIRIC ANTIBIOTIC GUIDELINES FOR SKIN AND SOFT TISSUE INFECTIONS IN PATIENTS ON PEDIATRIC SERVICES This guideline is designed to provide guidance in pediatric patients with a primary skin and soft tissue infection (SSTI).
Skin and Soft Tissue Infections: Treatment Guidance
Back to first page 6 Type of Infection Suspected Organisms Recommended Treatment Burn Wounds S. aureus, P. aeruginosa • Surgical debridement is essential for clinical cure • Topical antimicrobials may be beneficial, directed by
Practice Guidelines for the Diagnosis and Management of Skin and Soft ...
A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections.
Why is cephalexin used for cellulitis?
Cephalexin has long been used to treat uncomplicated cellulitis because of it’s activity against streptococci and methicillin-sensitive S. aureus (MSSA).
What is composite clinical cure rate?
Composite clinical cure rate (resolution of all symptoms and signs ), surgical drainage procedures, changes in erythema size, presence of swelling/induration and tenderness, invasive infections, skin infections at the same or different site, hospitalizations, similar infections in household contacts, days missed from normal activities and days of analgesic use
Is cellulitis an ED?
Background: Cellulitis is a common emergency department (ED) presentation. Despite the fact that diagnosis remains relatively straight forward, complexity remains in management in terms of the causative agent and appropriate antibiotic regimen. Though beta-hemolytic Streptococci are the most common causative agents there is increasing prevalence ...
How long does it take for cellulitis to heal?
Patients with cellulitis typically have symptomatic improvement within 24 to 48 hours of beginning antimicrobial therapy, although visible improvement of clinical manifestations in more severe cases may take up to 72 hours.
What is nonpurulent skin infection?
Nonpurulent infection — Forms of nonpurulent skin and soft tissue infection include cellulitis and erysipelas. (See "Cellulitis and skin abscess: Epidemiology, microbiology, clinical manifestations, and diagnosis", section on 'Cellulitis and erysipelas' .)
How long does oral therapy for MRSA last?
Patients with MRSA responsive to oral therapy are typically treated for 5 days; extension of the duration (up to 14 days) may be warranted in the setting of severe infection, slow response to therapy, or immunosuppression.
Is UpToDate a substitute for medical advice?
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of UpToDate content is governed by the UpToDate Terms of Use. ©2021 UpToDate, Inc. All rights reserved.
Does antimicrobial treatment help with abscess?
Antimicrobial therapy may also decrease the risk of recurrent skin abscess. In one randomized trial, new infections at one month of follow-up were less common among those who received clindamycin than those who received TMP-SMX or placebo [ 30 ].
Can corticosteroids be used for cellulitis?
We do not favor use of nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids in the setting of cellulitis; these drugs can mask signs and symptoms of inflammation in patients with necrotizing soft tissue infection and their use may be associated with delay in diagnosis.
Is purulence a secondary infection?
An infection involving purulence (whether the process began as an abscess [with secondary cellulitis] or as a cellulitis [with secondary purulence]) is potentially attributable to S. aureus, which should be reflected in the choice of empiric antimicrobial therapy.
What is the best antibiotic for cellulitis?
Narrow spectrum penicillins targeting streptococci and staphylococci (in the case of purulent infection) should be the mainstay of antimicrobial therapy. The natural history of cellulitis is one of slow resolution. Fever and inflammation often persist during the first 72 hours of treatment.
What is the term for an acute infection of the skin involving the dermis and subcutaneous tissues?
Cellulitis is simply defined as an acute infection of the skin involving the dermis and subcutaneous tissues. Erysipelas classically refers to a more superficial cellulitis of the face or extremities with lymphatic involvement, classically due to streptococcal infection.
Is cellulitis a clinical condition?
Cellulitis is a frequently encountered condition, but remains a challenging clinical entity. Under and overtreatment with antimicrobials frequently occurs and mimics cloud the diagnosis. Typical presentation, microbiology and management approaches are discussed. KEYWORDS: infection, cellulitis, OPAT, antibiotics.
Why is it important to take a shorter antibiotic regimen?
Because shorter courses of antibiotics have been shown to treat other bacterial infections effectively, a shorter antibiotic regimen may be just as effective as a longer regimen in treating uncomplicated cellulitis.
What is the most common etiologic organism in primary care?
One of the most common diagnoses in primary care is cellulitis. Streptococcus sp. and Staphylococcus aureus are the most common etiologic organisms of cellulitis and usually respond to empiric antibiotics. A seven- to 10-day regimen is the recommended treatment.
How long does it take for cellulitis to heal?
Patients with cellulitis typically have symptomatic improvement within 24 to 48 hours of beginning antimicrobial therapy, although visible improvement of clinical manifestations in more severe cases may take up to 72 hours.
What is nonpurulent skin infection?
Nonpurulent infection — Forms of nonpurulent skin and soft tissue infection include cellulitis and erysipelas. (See "Cellulitis and skin abscess: Epidemiology, microbiology, clinical manifestations, and diagnosis", section on 'Cellulitis and erysipelas' .)
How long does oral therapy for MRSA last?
Patients with MRSA responsive to oral therapy are typically treated for 5 days; extension of the duration (up to 14 days) may be warranted in the setting of severe infection, slow response to therapy, or immunosuppression.
Is UpToDate a substitute for medical advice?
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of UpToDate content is governed by the UpToDate Terms of Use. ©2021 UpToDate, Inc. All rights reserved.
Does antimicrobial treatment help with abscess?
Antimicrobial therapy may also decrease the risk of recurrent skin abscess. In one randomized trial, new infections at one month of follow-up were less common among those who received clindamycin than those who received TMP-SMX or placebo [ 30 ].
Can corticosteroids be used for cellulitis?
We do not favor use of nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids in the setting of cellulitis; these drugs can mask signs and symptoms of inflammation in patients with necrotizing soft tissue infection and their use may be associated with delay in diagnosis.
Is purulence a secondary infection?
An infection involving purulence (whether the process began as an abscess [with secondary cellulitis] or as a cellulitis [with secondary purulence]) is potentially attributable to S. aureus, which should be reflected in the choice of empiric antimicrobial therapy.