Fast Five Quiz: Cellulitis Key Aspects

Michael Stuart Bronze, MD


January 23, 2020

According to IDSA guidelines, patients with cellulitis who do not have systemic signs of infection should receive an antimicrobial agent active against streptococci. Patients with cellulitis who have systemic signs of infection should receive systemic antibiotics. For patients whose cellulitis is associated with penetrating trauma, evidence of MRSA infection elsewhere, nasal colonization with MRSA, injection drug use, or systemic inflammatory response syndrome, vancomycin or another antimicrobial effective against both MRSA and streptococci is recommended.

The recommended duration of antimicrobial therapy is 5 days; however, if the infection has not improved within that period, treatment should be extended. The IDSA also states that systemic corticosteroids may be considered in nondiabetic adult patients with cellulitis.

For patients with recurrent cellulitis, the IDSA recommends identifying and treating predisposing conditions, including edema, obesity, eczema, venous insufficiency, and toe web abnormalities. They recommend considering the use of prophylactic antibiotics (eg, oral penicillin or erythromycin bid for 4-52 weeks, intramuscular benzathine penicillin every 2-4 weeks) in patients who have three or four episodes of cellulitis per year despite attempts to treat or control predisposing factors.

Read more about the treatment of cellulitis.


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