Cellulitis - Simple and Erysipelas

Cellulitis - Simple and Erysipelas

See investigation and treatment guidelines in Hospital HealthPathways.

Pathogens

Common: S. pyogenes, S. aureus
Other: streptococci C and G

Drug Treatment

Consider early switch from IV to oral antimicrobials.
Duration: Usual total duration of treatment is at least 7 days, depending on response.
Use IV therapy initially for severe infections.

Empiric

flucloxacillin

HML Sched NZF PML noids

IV 2 g every six hours

then PO 1000 mg four times a day

fe = 0.7, consider adjusting dose if CrCl reduced.
Risk of hepatotoxicity is increased in females, patients > 55 years old, high doses, and courses longer than 14 days duration.

Mild penicillin allergy

cefazolin

HML Sched NZF PML noids

IV 2 g every eight hours

fe = 0.9, consider adjusting dose if CrCl is reduced.

followed by early switch to

cefalexin

HML Sched NZF PML

PO 500 mg four times a day

fe = 0.9, consider adjusting dose if CrCl is reduced.

Severe penicillin allergy

clindamycin

HML Sched NZF PML noids

PO 450 mg three times a day

Metabolised by CYP3A. (fe < 0.1).

Pathogens Known

S. aureus

methicillin sensitive - see empiric treatment
methicillin resistant (MRSA) - if colonised with MRSA consult with Infectious Diseases and see MRSA.

S. pyogenes/other streptococci

benzylpenicillin

HML Sched NZF PML noids

(Penicillin G)

IV 1.8 g (3 megaunits) every six hours

fe = 0.8, consider adjusting dose if CrCl is reduced.

followed by early switch to

phenoxymethylpenicillin

HML Sched NZF PML

(Penicillin V)

PO 500 mg four times a day

fe = 0.9, consider adjusting dose if CrCl is reduced.

OR

amoxicillin

HML Sched NZF PML noids

PO 500 mg three times a day

fe = 0.9, consider adjusting dose if CrCl is reduced.

Topic Code: 99260