9.3 Cellulitis
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Cellulitis – non purulent | Prefer β-lactams. Penicillin V 250-500 q6h Or Amoxicillin 500mg TDS (25-50 mg/kg/day) Or Cloxacillin 500mg QID (50mg/kg/day) Or Cephalexin 250- 500mg QID (25–50 mg/kg/day) Or Cefadroxil 500 mg q12h | Clindamycin: 300- 600mg BD/TID (20mg/kg/day) | Duration of therapy is 5 to 7 days based on clinical response. |
| Cellulitis- moderate to severe | Inj Cefazolin 1-2g q8h Or Inj Amoxicillin- clavulanate 1.2g TDS | Severe infection: Inj Cefuroxime 1.5g q8h Or Inj Clindamycin 600-900mg IV TDS (if allergic to penicillins) | Duration of therapy is 7 to 10 days based on clinical response. |
| Cellulitis with MRSA risk factors: Mild | Trimethoprim- sulfamethoxazole 800 mg/160 mg BD | Doxycycline 100 mg q12h | Duration of therapy is 5 to 10 days based on severity. A longer duration of antibiotic treatment may be a consideration in patients who show minimal improvement with antibiotic therapy within 48 hours. |
| Cellulitis in patients with comorbidities, poor response to oral antibiotics, immunocompromised, signs of deeper infection like bullae, skin sloughing or signs of systemic infection | Inj Piperacillin- tazobactam 4.5g q6h ± Vancomycin 15 to 20 mg/kg/dose every 8 to 12 hours along with surgical debridement | As per culture susceptibility reports | Duration of therapy is 7 to 10 days based on severity. |
For common etiological agents of Cellulitis, see Annexure B.9.3
Additional Information
- Bacteria causing infection below the skin surface leading to an acute superficial infection affecting the deep dermis and subcutaneous tissue is cellulitis. Cellulitis is relatively common, and most often occurs in middle-aged and older adults.
References
1. Dennis L. Stevens, Alan L. Bisno, Henry F. Chambers, E. Patchen Dellinger, Ellie J. C. Goldstein, Sherwood L. Gorbach, Jan V. Hirschmann, Sheldon L. Kaplan, Jose G. Montoya, James C. Wade, Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 59, Issue 2, 15 July 2014, Pages e10-e52, https://doi.org/10.1093/cid/ciu296