Treatment of Cellulitis with Fever

Initial Assessment and Antibiotic Selection

The World Journal of Emergency Surgery recommends treatment of cellulitis with fever should begin promptly with antibiotics effective against streptococci and, when indicated, staphylococci, with hospitalization for patients with systemic inflammatory response syndrome (SIRS) or other concerning features 1, 2
For non-purulent cellulitis with fever, antibiotics active against streptococci should be selected, which are the most common causative organisms 2
For mild to moderate cases without systemic toxicity, oral options include penicillin or amoxicillin (if streptococcal infection is strongly suspected) 2, 3

MRSA is not a typical cause of non-purulent cellulitis, and routine MRSA coverage is unnecessary 2, 3
Consider MRSA coverage only in specific situations, such as presence of purulent drainage 1, 2

Consider hospitalization if the patient has systemic inflammatory response syndrome (SIRS) 1, 2
Hospitalization is also recommended for patients with fever and significant systemic toxicity 1

A 5-day course of antimicrobial therapy is as effective as a 10-day course for uncomplicated cellulitis if clinical improvement occurs by day 5 2, 3
For more severe infections with fever, treatment may need to be extended until resolution of systemic symptoms 1

Elevate the affected area to promote gravity drainage of edema and inflammatory substances 2
Incision and drainage is the primary treatment for abscesses associated with cellulitis 1
Complex abscesses require incision and drainage with adjuvant antibiotic therapy, especially when systemic signs of infection are present 1