Facial cellulitis: Difference between revisions
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*Consider labs, blood cx if patient is immunocompromised, risk factors | *Consider labs, blood cx if patient is immunocompromised, risk factors, renal dysfunction | ||
*Bedside US to identify abscess | *Bedside US to identify abscess | ||
*CT can identify deep, extensive infection that involve soft tissues of neck or pharynx | *CT can identify deep, extensive infection that involve soft tissues of neck or pharynx | ||
Revision as of 23:19, 26 September 2016
Background
- Superficial soft tissue infection of the face
- Risk factors include immunosuppression, diabetes, vascular injury (due to radiation or trauma), foreign bodies
- Most commonly caused by S. progenies and S. aureus, including MRSA
Clinical Features
- Erythema, edema, warmth, pain
- Can be associated with chronic illness, trauma, insect bites, allergen exposure, dental caries, radiation exposure
- Consider severe illness or sepsis with systemic symptoms (fever, tachycardia, hypotension, AMS)
Differential Diagnosis
Infectious
- Cellulitis
- Impetigo
- Erysipelas
- Viral exanthem
- Parotitis
- Necrotizing fasciitis
- Anthrax
- Herpes zoster
- Malignant otitis externa
Trauma
- Soft tissue contusion
- Burn
Inflammatory
- Insect bite
- Apical abscess
- Contact dermatitis
Immunologic
- Systemic lupus erythematosus
- Vancomycin flushing reaction
- Angioneurotic edema
Evaluation
- Diagnosis is clinical
- Consider labs, blood cx if patient is immunocompromised, risk factors, renal dysfunction
- Bedside US to identify abscess
- CT can identify deep, extensive infection that involve soft tissues of neck or pharynx
Management
- Analgesics
- Remove foreign bodies from affected area if possible
- Abscesses should be drained
Antibiotics
Tailor antibiotics by regional antibiogram[1]
Outpatient
Coverage primarily for Strep
MRSA coverage only necessary if cellulitis associated with: purulence, penetrating trauma, known MRSA colonization, IV drug use, or SIRS[2]
- 5 day treatment duration, unless symptoms do not improve within that timeframe[2]
- Cephalexin 500mg PO q6hrs OR
- Clindamycin 450mg PO TID covers both Strep and Staph
- Tetracyclines (like Doxycycline) should be avoided in non-purulent cellulitis due to high rates of Strep resistance[5]
Inpatient
- Vancomycin 20mg/kg IV q12hrs OR
- Clindamycin 600mg IV q8hrs OR
- Linezolid 600mg IV q12hrs OR
- Daptomycin 4mg/kg IV once daily
coverage extended for Vibrio vulnificus
- Doxycycline 100mg PO/IV q12hrs daily + Cefepime 1g IV q12hrs x 10 days
- Ciprofloxacin 400mg IV q12hrs x 10 days
- Ciprofloxacin 750mg PO q12hrs x 10 days
coverage extended for Aeromonas sp
- Ciprofloxacin 400mg IV q12hrs x 10 days
- Ciprofloxacin 500mg PO q12hrs x 10 days
- TMP/SMX 2 DS tablets (5mg/kg) PO q12hrs x 10 days
- Ceftriaxone 1g (50mg/kg) IV q24hrs
Disposition
- Most patients can be treated with oral antibiotics as outpatient
- Consider admission for:
- systemic signs of sepsis
- antibiotic intolerance
- immunosuppression
- extensive areas of erythema or induration
- foreign bodies that cannot be removed in ED
- failure of outpatient therapy
See Also
External Links
References
- ↑ Stevens D, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-e52
- ↑ 2.0 2.1 Stevens D, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-e52
- ↑ Cadena J, et al. Dose of trimethoprim-sulfamethoxazole to treat skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus. Antimicrobial agents and chemotherapy 55.12 (2011): 5430-5432.
- ↑ Pallin D, et al. Clinical trial: comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial. Clinical infectious diseases 56.12 (2013): 1754-1762
- ↑ Traub, W and Leonhard, B. Comparative susceptibility of clinical group A, B, C, F, and G beta-hemolytic streptococcal isolates to 24 antimicrobial drugs. Chemotherapy 43.1 (1997):10-20.
- Tintinalli's Emergency Medicine 7th Edition, pg1557-8