Sandbox/Alejandro

Medical Therapy

• For patients with purulent cellulitis, cultures are recommended and empirical therapy for Community Associated-MRSA (CA-MRSA) should be started.
• For patients with non-purulent cellulitis, empirical therapy for β-hemolytic streptococci should be started.
• The duration of the therapy should be individualized for the clinical response of each patient; 5-10 days is usually recommended.
• The treatment of cellulitis in neonates usually requires hospitalization and parenteral therapy. Oral therapy is given for completion of the treatment when the pathogen is unknown.
• Optimal dose should be based on determination of serum concentrations.
• Patients with renal insufficiency may require dose adjustment in case of cephalosporins.
• Clindamycin is an alternate therapy for patients at risk of severe hypersensitivity reaction to penicillins and cephalosporins.
• Doxycycline is NOT recommended for children <8 years of age.
• Studies have shown an increase in treatment failure with TMP-SMX compared to other agents for cellulitis in children, reflecting TMP-SMX less action against Group A streptococcus.

Therapy based on Anatomical LocationAdapted from

▸ Click on the following categories to expand treatment regimens.

Location   ▸  Buccal   ▸  Periorbital   ▸  Orbital   ▸  Perianal   ▸  '   ▸  '   ▸  '

Buccal Cellulitis Preferred Regimen ▸ [[ OR ▸ [[ Alternative Regimen ▸ [[ OR ▸ [[ Periorbital Cellulitis Preferred Regimen ▸ [[ OR ▸ [[ Alternative Regimen ▸ [[ OR ▸ [[ Orbital Cellulitis Preferred Regimen ▸ [[ OR ▸ [[ Alternative Regimen ▸ [[ OR ▸ [[ Perianal Cellulitis Preferred Regimen ▸ [[ OR ▸ [[ Alternative Regimen ▸ [[ OR ▸ [[ ## Cellulitis Preferred Regimen ▸ [[ OR ▸ [[ Alternative Regimen ▸ [[ OR ▸ [[

Special ConsiderationsAdapted from

For the following conditions, an additional antibiotic therapy should be added to the usual regimen in order to cover specific pathogens associated to those circumstances.

▸ Click on the following categories to expand treatment regimens.

Special Considerations   ▸  Diabetic Foot Ulcer   ▸  Neutropenic Patients   ▸  Sal Water Wound Exposure   ▸  Fresh Water Wound Exposure   ▸  Butcher, Fisherman, Veterinarian

Diabetic Foot Ulcer Neutropenic Patients ▸ The initial therapy consist of empirical broad-spectrum antibiotics. ▸ The final therapy for would depend on the severity of the cellulitis and the isolated pathogen Salt Water Wound Exposure (Vibrio vulnificus) Preferred Regimen ▸ Doxycycline 200 mg IV initial dose, then 50-100 mg IV q12h Alternative Regimen ▸ Cefotaxime OR ▸ Ciprofloxacin Fresh Water Wound Exposure (Aeromonas spp) Preferred Regimen ▸ Ciprofloxacin 400mg IV q12h OR ▸ Ceftazidime PLUS ▸ Gentamicin Alternative Regimen ▸ Meropenem OR ▸ Imipenem-cilastatin Butcher, Fisherman, Veterinarian (Erysipelothrix rhusiopathiae) Preferred Regimen ▸ Amoxicillin 500 mg PO q8hr Alternative Regimen ▸ Ciprofloxacin OR ▸ Cefotaxime OR ▸ Imipenem-cilastatin