Treatment of Cellulitis

Initial Assessment and Classification

The Infectious Diseases Society of America recommends assessing for systemic signs of infection to determine severity and appropriate treatment setting 1, 5
Cultures of blood or cutaneous aspirates are not routinely recommended for typical cases of cellulitis, according to the Infectious Diseases Society of America 1, 4
Blood cultures should be obtained for patients with malignancy, severe systemic features, or unusual predisposing factors, as recommended by the Infectious Diseases Society of America 4, 6

For mild nonpurulent cellulitis, the Infectious Diseases Society of America recommends using antibiotics active against streptococci, such as penicillin 1, amoxicillin 6, dicloxacillin 6, cephalexin 6, or clindamycin [4, 6] [1, 4, 6]
For moderate to severe nonpurulent cellulitis, consider coverage for both streptococci and methicillin-susceptible S. aureus (MSSA), as recommended by the Infectious Diseases Society of America 1, 5

A 5-day course of antimicrobial therapy is recommended for uncomplicated cellulitis, according to the Infectious Diseases Society of America and the American College of Physicians 1, 2, 3
Treatment should be extended if the infection has not improved within 5 days, as recommended by the Infectious Diseases Society of America and the American College of Physicians 1, 3

Outpatient therapy is recommended for patients without systemic inflammatory response syndrome (SIRS), altered mental status, or hemodynamic instability, according to the Infectious Diseases Society of America 1, 5
Hospitalization is recommended for patients with concern for deeper or necrotizing infection, poor adherence to therapy, severe immunocompromise, or failing outpatient treatment, as recommended by the Infectious Diseases Society of America 1, 5, 7

Elevation of the affected area to promote gravity drainage of edema and inflammatory substances is recommended, according to the Infectious Diseases Society of America 1, 4
Treatment of predisposing factors such as edema, obesity, eczema, venous insufficiency, and toe web abnormalities is recommended, as suggested by the Infectious Diseases Society of America 1, 5

Identify and treat predisposing conditions, such as edema, obesity, eczema, venous insufficiency, and toe web abnormalities, to prevent recurrence, as recommended by the Infectious Diseases Society of America 1, 5
For patients with 3-4 episodes of cellulitis per year despite treatment of predisposing factors, consider prophylactic antibiotics, such as oral penicillin or erythromycin, or intramuscular benzathine penicillin, as recommended by the Infectious Diseases Society of America 1, 5, 7