MANAGEMENT OF CELLULITIS IN ADULTS

Diagnosis Treatment Flu-like symptoms, malaise, onset of 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