Cellulitis Treatment Guidelines

Antibiotic Selection

The Infectious Diseases Society of America recommends first-line therapy with an antibiotic active against streptococci, such as penicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, cephalexin, or clindamycin for uncomplicated cellulitis 1, 2
A 5-day course of antimicrobial therapy is as effective as a 10-day course if clinical improvement has occurred by day 5 1, 2
For moderate infections with systemic signs, consider coverage for both streptococci and methicillin-susceptible S. aureus (MSSA) 2, 3

MRSA is an unusual cause of typical cellulitis, and treatment specifically targeting this organism is usually unnecessary in uncomplicated cases 1
Coverage for MRSA may be prudent in cellulitis associated with penetrating trauma, purulent drainage, or concurrent evidence of MRSA infection elsewhere 1, 3

Elevation of the affected area to promote gravity drainage of edema and inflammatory substances is recommended 1, 2
Treatment of predisposing conditions, such as tinea pedis, trauma, or venous eczema, is recommended 1, 2
Systemic corticosteroids could be considered in non-diabetic adult patients to reduce inflammation 1

Outpatient therapy is recommended for patients who do not have SIRS, altered mental status, or hemodynamic instability 2, 3
Hospitalization is recommended if there is concern for deeper or necrotizing infection, poor adherence to therapy, infection in a severely immunocompromised patient, or failure of outpatient treatment 2, 3

Identify and treat predisposing conditions such as edema, obesity, eczema, venous insufficiency, and toe web abnormalities 2
For patients with 3-4 episodes of cellulitis per year despite treatment of predisposing factors, consider prophylactic antibiotics 2

Blood cultures should be obtained in patients with malignancy, severe systemic features, or unusual predisposing factors 1, 3