Management of Cellulitis in Diabetic Patients

Antibiotic Selection

The American College of Physicians and the Infectious Diseases Society of America recommend first-line outpatient treatment with antibiotics active against both streptococci and Staphylococcus aureus, such as amoxicillin-clavulanate, trimethoprim-sulfamethoxazole, or clindamycin for mild to moderate infections in diabetic patients 1, 2
For mild infections without systemic symptoms, oral antibiotics such as dicloxacillin, cephalexin, clindamycin, trimethoprim-sulfamethoxazole, or amoxicillin-clavulanate are appropriate 1, 2
For moderate infections with some systemic symptoms, oral antibiotics such as amoxicillin-clavulanate, trimethoprim-sulfamethoxazole, levofloxacin, or levofloxacin with clindamycin are recommended 1, 2

The Infectious Diseases Society of America recommends an initial duration of antimicrobial therapy of 5 days, with extension of treatment if the infection has not improved within this time period 4, 5
Evaluation of response to therapy should be done every 2-5 days initially for outpatients, with primary indicators of improvement being resolution of local and systemic symptoms and clinical signs of inflammation 1, 2

Elevation of the affected area to reduce edema, careful examination and treatment of interdigital toe spaces, and identification and treatment of predisposing conditions such as edema, venous insufficiency, and toe web abnormalities are recommended 4, 5
For patients with recurrent cellulitis, prophylactic antibiotics such as oral penicillin or erythromycin may be considered 4, 5