Cellulitis Treatment Guidelines

Introduction to Cellulitis Treatment

The Infectious Diseases Society of America recommends cephalexin 500 mg four times daily or dicloxacillin 500 mg four times daily for 5 days for outpatient non-purulent cellulitis 1
For purulent cellulitis or MRSA risk, the Infectious Diseases Society of America recommends trimethoprim-sulfamethoxazole 1-2 double-strength tablets twice daily or clindamycin 300-450 mg four times daily for 5-10 days 1, 5

For non-purulent cellulitis, the Infectious Diseases Society of America recommends cephalexin 500 mg four times daily or dicloxacillin 500 mg four times daily for 5 days 1
For purulent cellulitis, the Infectious Diseases Society of America recommends trimethoprim-sulfamethoxazole 1-2 double-strength tablets twice daily or clindamycin 300-450 mg four times daily for 5-10 days 1, 5
The American Academy of Pediatrics recommends avoiding tetracyclines in children <8 years 4, 5, 7

For severe cellulitis with systemic signs, the Infectious Diseases Society of America recommends vancomycin 15 mg/kg every 12 hours IV or ceftaroline 600 mg every 12 hours IV for 7-14 days 1, 2
The Infectious Diseases Society of America recommends linezolid 600 mg every 12 hours IV or PO for complicated or severe infections 4, 5, 7

For outpatient pediatric doses, the American Academy of Pediatrics recommends cephalexin 25-50 mg/kg/day in 4 divided doses or TMP-SMX 8-12 mg/kg/day (based on trimethoprim) in 2-4 divided doses 1
For hospitalized pediatric doses, the American Academy of Pediatrics recommends vancomycin 40 mg/kg/day in 4 divided doses IV or clindamycin 10-13 mg/kg/dose every 6-8 hours IV (40 mg/kg/day total) if local clindamycin resistance <10% 1, 4, 5, 7

The Infectious Diseases Society of America recommends adding empiric MRSA coverage in outpatients with purulent drainage without drainable abscess, failure to respond to beta-lactam therapy, systemic toxicity present, or known MRSA risk factors 4, 5, 7
The Infectious Diseases Society of America recommends hospitalizing patients with SIRS criteria or hemodynamic instability, altered mental status, concern for necrotizing infection, severe immunocompromise, or failed outpatient therapy 2, 3, 6

The Infectious Diseases Society of America recommends a treatment duration of 5 days minimum for mild outpatient cellulitis, 5-10 days for moderate outpatient cellulitis, and 7-14 days for severe hospitalized cellulitis 1, 4, 5, 6
The Infectious Diseases Society of America recommends extending treatment duration if no improvement at initial endpoint 1, 6