Cellulitis medical therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindvarjhulla, M.B.B.S.
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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
Since the most common causative pathogen of cellulitis is Staphylococcus aureus, a gram positive bacteria, the disease is empirically treated with Beta-lactam antibiotics. Latest reports suggest that this bacterium has acquired resistance (MRSA) and newer drugs are to be used to kill off the pathogen. Reports from the laboratory regarding the sensitivity of the pathogen is a key factor in deciding the therapy.
Choice of the antibiotic therapy for cellulitis depends on few factors:
- Age of the individual
- Co-morbid conditions
- Site of lesion
- Severity of lesion
- Pathogen involved (gram positive or negative and aerobic or anaerobic)
- Strain and resistance of the pathogen
The classifications of cellulitis that are accounted for by different antibiotic therapies are:
Uncomplicated Cellulitis
- In cases of simple infection without abscesses or draining, dicloxacillin, amoxacillin or first generation cephalosporins like cephalexin are used.
- Patients allergic to penicillin drugs can be given macrolide antibiotics like azithromycin.
Severe Cellulitis
- In severe cases of the disease, parenteral therapy is advocated.
- Higher generations of cephalosporins such as ceftrioxone, and cefuroxime are used.
- Patients with a penicillin allergy can be given vancomycin and clindamycin.
- In diabetic individuals, broad coverage antibiotics are used. Carbapenams, Beta-lactam antibiotics with Beta-lactamase inhibitors are given in a combined regimen for antibiotic coverage.
Special Cases
- MRSA - Methicillin resistant Staphylococcus Aureus.
- MRSA is commonly the causative agent of cellulitis in cases presenting with abscesses.[1]
- In mild cases, treatment will be trimoxazole with doxycycline.
- In severe cases, the most cost effective therapy will be vancomycin.[2]
- Bite Wounds (Mammalian).
- Bite wounds suffered from a mammal often contain polymicrobial sources that are anaerobic in nature.[3]
- Mild cases can be treated with amoxicillin and clavulanate, and in cases of penicillin allergy cotrimoxazole along with metronidazole is used.
- In severe cases, piperacillin and tazobactum are used.
- Acquatic punctures and lacerations.[4]
- This is seen mainly in professional swimmers and divers both in freshwater and in brackish water.
- Failure to recognize these wounds and delay treatment may cause a larger morbidity.
- Wounds in fresh water are treated with doxycycline and ceftazidime (or fluroquinolones).
- Wounds in brackish water are treated with ceftazidime and levofloxacin.
References
- ↑ Moran GJ, Krishnadasan A, Gorwitz RJ; et al. (2006). "Methicillin-resistant S. aureus infections among patients in the emergency department". N. Engl. J. Med. 355 (7): 666–74. doi:10.1056/NEJMoa055356. PMID 16914702. Unknown parameter
|month=ignored (help) - ↑ Stryjewski ME, Chambers HF (2008). "Skin and soft-tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus". Clin. Infect. Dis. 46 Suppl 5: S368–77. doi:10.1086/533593. PMID 18462092. Unknown parameter
|month=ignored (help) - ↑ Abrahamian FM, Goldstein EJ (2011). "Microbiology of animal bite wound infections". Clin. Microbiol. Rev. 24 (2): 231–46. doi:10.1128/CMR.00041-10. PMC 3122494. PMID 21482724. Unknown parameter
|month=ignored (help) - ↑ Noonburg GE (2005). "Management of extremity trauma and related infections occurring in the aquatic environment". J Am Acad Orthop Surg. 13 (4): 243–53. PMID 16112981.