Cellulitis and Erysipelas

Click on any antibiotic to mark it as excluded from print.

Cellulitis and Erysipelas
Definition Signs/ Symptoms Management
Initial Empirical Therapy Comment
Cellulitis and erysipelas manifest as areas of skin erythema, edema, and warmth; they develop as result of bacterial entry via breaches in the skin barrier. Skin erythema , edema , warmth. Erysipelas lesions are raised above the level of surrounding skin with clear demarcation between involved and uninvolved skin. A skin abscess manifests as a painful, fluctuant, erythematous nodule with or without surrounding cellulitis
There is No indication for MRSA coverage:

Select one of the following antibiotics:

  • Cefazolin 1 - 2 g every 8 hours
  • Nafcillin 1 - 2 g every 4 hours
  • Flucloxacillin 2 g every 6 hours
  • Clindamycin 450 mg orally every 8 hours
Conditions that warrant MRSA coverage :
  • Systemic signs of toxicity (e.g., fever > 38 C,hypotension, sustained tachycardia)
  • Cellulitis with purulent wound drainage
  • Known MRSA colonization or infection
  • ≥Injection drug use
  • High-risk neutropenia
There is indication for MRSA coverage:

Select one of the following antibiotics:

  • Vancomycin 20 - 35 mg/kg/loading then 15- 20mg/kg IV every 8 to 12 hours
  • Daptomycin 4 - 6 mg/kg every 24 hours (alternative)
Severe sepsis:

Select one of the following antibiotics:

  • Vancomycin 20 - 35 mg/kg/loading then 15- 20mg/kg IV every 8 to 12 hours
  • Daptomycin 4 - 6 mg/kg every 24 hours (alternative)

Plus:

Select one of the following:

  • Cefepime 2 g every 8 hours
  • Meropenem 1 g every 8 hours
Duration: 5 - 14 days depending on severity and clinical response
References:

Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 , last update 2018