MANAGEMENT OF CELLULITIS IN ADULTS

Diagnosis
Flu-like symptoms, malaise, onset of Treatment
UNILATERAL swelling, pain, redness

Consider tinea pedis as site of entry – treat with antifungal cream

Decide Classification
First line Second line or penicillin allergy
Class I Flucloxacillin 1g qds po Clindamycin 300mg tds po
Class I Class II Class III Class IV Class II Flucloxacillin 1g qds IV * or Clindamycin 600mg qds IV or
Patients have no Patients are Patients may have a Patients have Ceftriaxone 1g od IV (OPHAT) 450mg tds po
signs of systemic either significant systemic sepsis syndrome Class III Flucloxacillin 1g qds IV * Clindamycin 600mg qds IV
toxicity, have no systemically ill or upset such as acute or severe life Class Benzylpenicillin 2.4g 2-4 hourly IV + ciprofloxacin 400mg bd IV
uncontrolled co- systemically well confusion, threatening IV + clindamycin 600mg – 1.2g qds IV
morbidities and but with a co- tachycardia, infections such (If allergic to penicillin use ciprofloxacin and clindamycin only) – for
can be managed morbidity such as tachypnoea, as necrotising more information refer to Penicillin Hypersensitivity Guideline.
with oral peripheral hypotension, or may fasciitis. NB Discuss with local ID or Microbiology service
antimicrobials on vascular disease, have unstable co-
an outpatient chronic venous morbidities that may
basis. insufficiency or interfere with a *Note: Do NOT use Flucloxacillin IV 2g qds unless patient is
morbid obesity response to therapy very obese.
which may or have a limb
complicate or threatening infection
delay resolution due to vascular Suggested criteria for oral Suitable agents for oral switch therapy
of their infection. compromise. switch and/or discharge
• Pyrexia settling • Flucloxacillin 1g qds
• Co-morbidities stable If penicillin allergy -
• Less intense erythema • Clindamycin 300mg tds if <90kg
Lab Investigations • Falling inflammatory markers • Clindamycin 450mg tds if >90kg

Class II – IV Selected Patients Prophylaxis for recurrent cellulitis

• FBC • Blood cultures - Class III or IV only • Discuss with Infection specialist prior to prescribing
• CRP • 2 or more episodes at the same site
• U+E • Penicillin V 250mg bd or Erythromycin 250mg bd for up to 2 years
• Culture any ulceration or
blister fluid Adapted from Clinical Resource Efficiency
ASD Anti-infectives Committee Support Team Guidelines 2005
June 2007 Review June 2008 www.crestni.org.uk