MANAGEMENT OF CELLULITIS IN ADULTS

Diagnosis Treatment
Flu-like symptoms, malaise, onset of
UNILA TE RAL swelling, pain, redness
Consider Tinea pedis as site of entry – treat with antifungal cream
e.g. terbinafine 1% cream twice daily for 7 days

Asse ss se verity and MRSA ri sk. If patient is diabetic or has a

chronic wound also refer to additional guidance. First line Penicillin allergy or at risk of MRS A
Doxycycline oral 100mg BD
for 7 days
Flucloxacillin oral 1g QDS
Septic Shock and/or
Mild Sepsi s for 7 days
Necroti sing Fa sciiti s (NF) If not resolving and penicillin allergy:
No signs of Systemically unwell Evidence of end organ dysfunction Mild
Clindamycin (see dosing in oral switch
systemic toxicity and/or NEWS ≥5 despite fluid resuscitation If not resolving: Doxycycline
box below)
and can be 100mg BD for 7 days
If not resolving and MRSA risk: seek
managed with and/or
ID/Micro advice
oral antimicrobials
on an outpatient local signs of necrotising fasciitis Flucloxacillin 1g QDS IV Vancomycin IV
basis or in (e.g. pain / systemic upset Sepsi s Increase to 2g QDS if BMI>30 (see vancomycin guideline)
primary care. disproportionate to appearance, Step down: Flucloxacillin oral Step down: Doxycycline oral
bullae, haemorrhage / bruising, rapid
progression, crepitus) Request URGENT Plastic / General Surgical review if suspicion of NF
Di scuss with ID or Micro within 24 hours of admission

Flucloxacillin 2g IV QDS + Penicillin allergy:

Septic
Clindamycin 1.2g IV QDS +
Shock Clindamycin 1.2g IV QDS +
Gentamicin 7mg/kg IV Gentamicin 7mg/kg IV
and/or
(see gentamicin guideline) (see gentamicin guideline)
Necroti sing
Investigations Fasciiti s
Note: Fournier’s Gangrene - At ri sk of MRS A:
• FBC piperacillin/tazobactam IV 4.5g tds As above +
• CRP + clindamycin IV 1.2g tds Vancomcyin IV
• U+E + gentamicin IV
(see vancomycin guideline)
• Culture any exudate
• Blood Cultures (not for mild cases) Suggested criteria for oral Suitable agents for oral switch therapy
• Glucose switch and/or discharge
• Lactate (not for mild cases)  Pyrexia settling • Flucloxacillin 1g qds
 Less intense erythema Penicillin allergy -
 Falling inflammatory • Doxycycline 100mg bd
OHP AT Service: or
markers
Dev eloped by : Antimicrobial Management For patients who may be suitable for IV
AND • Clindamycin 300mg tds <50kg
Group outpatient therapy please follow referral • Clindamycin 450mg tds 50-90kg
Date: 2006  meets IV to Oral S witch
Updated: Nov 2017
proce ss • Clindamycin 600mg tds or 450mg qds >90kg or very severe
criteria ..............................................................................................
Rev iew: Nov 2019
MRSA and not doxycycline sensitive - Seek ID/Micro advice