Sandbox/cellulitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2]

Cellulitis Microchapters
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Overview

Typically a combination of intravenous and oral antibiotics are administered for the treatment of cellulitis. Bed rest and elevation of the affected limbs are recommended to accompany the antibiotic treatment. In patients with edema of the extremities, compressive stockings may really aid in treating the fluid accumulation. Small abscesses surrounding the affected tissue can be treated with a simple incision and drainage of the fluid. It is advised to drink plenty of fluids during your treatment and recovery.

Medical Therapy

Empiric Therapy for Cellulitis in Neonates

▸ Click on the following categories to expand treatment regimens.

Preferred Regimen   ▸  Infants 0 to 4 weeks of age   ▸  Infants <1 week of age   ▸  Infants ≥1 week of age

Infants 0 to 4 weeks of age Parental Regimen ▸ Vancomycin 15 mg/kg IV q24h PLUS ▸ Cefotaxime 50 mg/kg IV q12h OR ▸ Gentamicin 2.5 mg/kg IV q18-24h Infants 0 to 4 weeks of age Oral Regimen ▸ Clindamycin 5 mg/kg orally q12h OR ▸ Linezolid 10 mg/kg orally q8-12h Infants <1 week of age (BW 1200 to 2000 g) Parental Regimen ▸ Vancomycin 10 to 15 mg/kg IV q12-18h PLUS ▸ Cefotaxime 50 mg/kg IV q12h OR ▸ Gentamicin 2.5 mg/kg IV q12h Infants <1 week of age (BW 1200 to 2000 g) Oral Regimen ▸ Clindamycin 5 mg/kg orally q12h OR ▸ Linezolid 10 mg/kg orally q8-12h Infants <1 week of age (BW >2000 g) Parental Regimen ▸ Vancomycin 10 to 15 mg/kg IV q8-12h PLUS ▸ Cefotaxime 50 mg/kg IV q8-12h OR ▸ Gentamicin 2.5 mg/kg IV q12h Infants <1 week of age (BW >2000 g) Oral Regimen ▸ Clindamycin 5 mg/kg orally q8h OR ▸ Linezolid 10 mg/kg orally q8-12h Infants ≥1 week of age (BW 1200 to 2000 g) Parental Regimen ▸ Vancomycin 10 to 15 mg/kg IV q8-12h PLUS ▸ Cefotaxime 50 mg/kg IV q8h OR ▸ Gentamicin 2.5 mg/kg IV q8-12h Infants ≥1 week of age (BW 1200 to 2000 g) Oral Regimen ▸ Clindamycin 5 mg/kg orally q8h OR ▸ Linezolid 10 mg/kg orally q8h Infants ≥1 week of age (BW > 2000 g) Parental Regimen ▸ Vancomycin 10 to 15 mg/kg IV q6-8h PLUS ▸ Cefotaxime 50 mg/kg IV q6-8h OR ▸ Gentamicin 2.5 mg/kg IV q8h Infants ≥1 week of age (BW > 2000 g) Oral Regimen ▸ Clindamycin 5 mg/kg orally q6h OR ▸ Linezolid 10 mg/kg orally q8h

Note:

• Treatment of cellulitis in neonates usually requires hospitalization and parenteral therapy. Oral therapy is given for completion of the treatment when the patogen is unknown.
• Optimal dose should be based on determination of serum concentrations.

Empiric Therapy for Non-purulent Cellulitis (including MSSA)

▸ Click on the following categories to expand treatment regimens.

Preferred Regimen   ▸  Adults   ▸  Children age >28 days

Adults Parental Regimen ▸ Cefazolin 1-2 g IV q8h OR ▸ Oxacillin 2g IV q4h OR ▸ Nafcillin 2g IV q4h Alternative Regimen ▸ Clindamycin 600-900 mg IV q8h Adults Oral Regimen ▸ Dicloxacillin 500 mg orally q6h OR ▸ Cephalexin 500 mg orally q6h Alternative Regimen ▸ Clindamycin 300-450 mg orally q6-8h

Children age >28 days Parental Regimen ▸ Cefazolin 100 mg/kg per day IV in 3-4 doses OR ▸ Oxacillin 150-200 mg/kg per day IV in 4-6 doses OR ▸ Nafcillin 150-200 mg/kg per day IV in 4-6 doses Alternative Regimen ▸ Clindamycin 25-40 mg/kg per day IV in 3-4 doses Children age >28 days Oral Regimen ▸ Dicloxacillin 25-50 mg/kg per day orally in 4 doses OR ▸ Cephalexin 25-50 mg/kg per day orally in 3-4 doses Alternative Regimen ▸ Clindamycin 20-30 mg/kg per day orally in 4 doses

Note:

• The above antibiotic regimen is NOT for initial empirical treatment of infections involving the face.
• Dose alteration for renal insufficiency may be needed in case of cephalosporins.
• Clindamycin is an alternate therapy for patients at risk of severe hypersensitivity reaction to penicillins and cephalosporins.

Empiric Therapy for MRSA

▸ Click on the following categories to expand treatment regimens.

Preferred Regimen   ▸  Adults   ▸  Children age >28 days

Adults Parental Regimen ▸ Cefazolin 1-2 g IV q8h OR ▸ Oxacillin 2g IV q4h OR ▸ Nafcillin 2g IV q4h Alternative Regimen ▸ Clindamycin 600-900 mg IV q8h Adults Oral Regimen ▸ Dicloxacillin 500 mg orally q6h OR ▸ Cephalexin 500 mg orally q6h Alternative Regimen ▸ Clindamycin 300-450 mg orally q6-8h

Children age >28 days Parental Regimen ▸ Cefazolin 100 mg/kg per day IV in 3-4 doses OR ▸ Oxacillin 150-200 mg/kg per day IV in 4-6 doses OR ▸ Nafcillin 150-200 mg/kg per day IV in 4-6 doses Alternative Regimen ▸ Clindamycin 25-40 mg/kg per day IV in 3-4 doses Children age >28 days Oral Regimen ▸ Dicloxacillin 25-50 mg/kg per day orally in 4 doses OR ▸ Cephalexin 25-50 mg/kg per day orally in 3-4 doses Alternative Regimen ▸ Clindamycin 20-30 mg/kg per day orally in 4 doses

Note:

References

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