Template:Cellulitis antibiotics: Difference between revisions
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''taylor antibiotics by regional antibiogram''<ref>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</ref>
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====Outpatient====
<translate>
''Coverage primarily for Strep''<br />
<!--T:1-->
''Tailor antibiotics by regional antibiogram''<ref>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</ref>


''[[MRSA]] coverage only necessary if cellulitis associated with: purulence, penetrating trauma, known MRSA colonization, IV drug use, or SIRS''<ref name="IDSA guidelines">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</ref>
====Outpatient==== <!--T:2-->
 
<!--T:3-->
''Coverage primarily for [[Special:MyLanguage/Strep|Strep]]''<br />
 
<!--T:4-->
''[[Special:MyLanguage/MRSA|MRSA]] coverage only necessary if cellulitis associated with: purulence, penetrating trauma, known MRSA colonization, IV drug use, or SIRS''<ref name="IDSA guidelines">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</ref>
*5 day treatment duration, unless symptoms do not improve within that timeframe<ref name="IDSA guidelines" />
*5 day treatment duration, unless symptoms do not improve within that timeframe<ref name="IDSA guidelines" />
**[[Cephalexin]] 500mg PO q6hrs OR
**[[Special:MyLanguage/Cephalexin|Cephalexin]] 500mg PO q6hrs '''OR'''
***Add [[TMP/SMX]] 1DS PO BID<ref>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.</ref> if [[MRSA]] is suspected
***Add [[Special:MyLanguage/TMP/SMX|TMP/SMX]] DS 1 tab PO BID<ref>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.</ref> if [[Special:MyLanguage/MRSA|MRSA]] is suspected
***Most cases of non-purulent cellulitis are thought caused by Strep. In these cases, the addition of TMP/SMX has been demonstrated to offer no clinical benefit over cephalexin alone.<ref>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</ref>
***Most cases of non-purulent cellulitis are caused by Strep. In these cases, the addition of TMP/SMX has been demonstrated to offer no clinical benefit over cephalexin alone.<ref>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</ref>
**[[Clindamycin]] 450mg PO TID
**[[Special:MyLanguage/Clindamycin|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<ref>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.</ref>
**Tetracyclines (like [[Special:MyLanguage/Doxycycline|Doxycycline]]) should be avoided in non-purulent cellulitis due to high rates of Strep resistance<ref>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.</ref>
 
 
====Inpatient==== <!--T:5-->
 
<!--T:6-->
*[[Special:MyLanguage/Vancomycin|Vancomycin]] 20mg/kg IV q12hrs '''OR'''
*[[Special:MyLanguage/Clindamycin|Clindamycin]] 600mg IV q8hrs '''OR'''
*[[Special:MyLanguage/Linezolid|Linezolid]] 600mg IV q12hrs '''OR'''
*[[Special:MyLanguage/Daptomycin|Daptomycin]] 4mg/kg IV once daily
 


====Inpatient====
====Saltwater related cellulitis==== <!--T:7-->
*[[Vancomycin]] 20mg/kg IV q12hrs OR
*[[Clindamycin]] 600mg IV q8hrs OR
*[[Linezolid]] 600mg IV q12hrs OR
*[[Daptomycin]] 4mg/kg IV once daily


====Saltwater related cellulitis====
<!--T:8-->
''coverage extended for [[Vibrio vulnificus]]''
''coverage extended for [[Special:MyLanguage/Vibrio vulnificus|Vibrio vulnificus]]''
*[[Doxycycline]] 100mg PO/IV q12hrs daily + [[Cefepime]] 1g IV q12hrs x 10 days
*[[Special:MyLanguage/Doxycycline|Doxycycline]] 100mg PO/IV q12hrs daily + [[Special:MyLanguage/Cefepime|Cefepime]] 1g IV q12hrs x 10 days
*[[Ciprofloxacin]] 400mg IV q12hrs x 10 days
*[[Special:MyLanguage/Ciprofloxacin|Ciprofloxacin]] 400mg IV q12hrs x 10 days
*[[Ciprofloxacin]] 750mg PO q12hrs x 10 days
*[[Special:MyLanguage/Ciprofloxacin|Ciprofloxacin]] 750mg PO q12hrs x 10 days


====Freshwater related cellulitis====
''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


===Predictors of Treatment Failure<ref>Peterson D. et al. Predictors of failure of empiric outpatient antibiotic therapy in emergency department patients with uncomplicated cellulitis. Acad Emerg Med. 2014 May;21(5):526-31.</ref>===
====Freshwater related cellulitis==== <!--T:9-->
*Fever (T>38°C) at triage (odds ratio [OR] 4.3)
*Chronic leg ulcers (OR 2.5)
*Chronic edema or lymphedema (OR 2.5)
*Prior cellulitis in the same area (OR 2.1)
*Cellulitis at a wound site (OR 1.9)


==References==
<!--T:10-->
<references/>
''coverage extended for [[Special:MyLanguage/Aeromonas sp|Aeromonas sp]]''
*[[Special:MyLanguage/Ciprofloxacin|Ciprofloxacin]] 400mg IV q12hrs  x 10 days
*[[Special:MyLanguage/Ciprofloxacin|Ciprofloxacin]] 500mg PO q12hrs x 10 days
*[[Special:MyLanguage/TMP/SMX|TMP/SMX]] 2 DS tablets (5mg/kg) PO q12hrs x 10 days
*[[Special:MyLanguage/Ceftriaxone|Ceftriaxone]] 1g (50mg/kg) IV q24hrs
</translate>

Latest revision as of 15:58, 27 January 2026

Other languages:

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
      • Add TMP/SMX DS 1 tab PO BID[3] if MRSA is suspected
      • Most cases of non-purulent cellulitis are caused by Strep. In these cases, the addition of TMP/SMX has been demonstrated to offer no clinical benefit over cephalexin alone.[4]
    • 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


Saltwater related cellulitis

coverage extended for Vibrio vulnificus


Freshwater related cellulitis

coverage extended for Aeromonas sp

  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
  2. ↑ 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
  3. ↑ 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.
  4. ↑ 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
  5. ↑ 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.
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