Template:Cellulitis antibiotics: Difference between revisions

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''Tailor antibiotics by regional antibiogram''
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''Tailor antibiotics by regional antibiogram''<ref>Stevens D, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-e52</ref>


====Outpatient====
====Outpatient====
*5 day treatment duration
**{{AntibioticDose|disease=Cellulitis|drug=Cephalexin|dose=500mg PO q6hrs|context=Outpatient}} '''OR'''
***Add {{AntibioticDose|disease=Cellulitis|drug=Trimethoprim-Sulfamethoxazole DS|display=TMP/SMX|dose=DS 1 tab PO BID|context=Outpatient, MRSA|link=no}} if MRSA suspected
**{{AntibioticDose|disease=Cellulitis|drug=Clindamycin|dose=450mg PO TID|context=Outpatient}} covers Strep and Staph


''Coverage primarily for [[Special:MyLanguage/Strep|Strep]]''<br />


''[[Special:MyLanguage/MRSA|MRSA]] coverage only necessary if cellulitis associated with: purulence, penetrating trauma, known MRSA colonization, IV drug use, or SIRS''<ref name="IDSA guidelines">Stevens D, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-e52</ref>
*5 day treatment duration, unless symptoms do not improve within that timeframe<ref name="IDSA guidelines" />
**[[Special:MyLanguage/Cephalexin|Cephalexin]] 500mg PO q6hrs '''OR'''
***Add [[Special:MyLanguage/TMP/SMX|TMP/SMX]] DS 1 tab PO BID<ref>Cadena J, et al. Dose of trimethoprim-sulfamethoxazole to treat skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus. Antimicrobial agents and chemotherapy 55.12 (2011): 5430-5432.</ref> if [[Special:MyLanguage/MRSA|MRSA]] is suspected
***Most cases of non-purulent cellulitis are caused by Strep. In these cases, the addition of TMP/SMX has been demonstrated to offer no clinical benefit over cephalexin alone.<ref>Pallin D, et al. Clinical trial: comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial. Clinical infectious diseases 56.12 (2013): 1754-1762</ref>
**[[Special:MyLanguage/Clindamycin|Clindamycin]] 450mg PO TID covers both Strep and Staph
**Tetracyclines (like [[Special:MyLanguage/Doxycycline|Doxycycline]]) should be avoided in non-purulent cellulitis due to high rates of Strep resistance<ref>Traub, W and Leonhard, B. Comparative susceptibility of clinical group A, B, C, F, and G beta-hemolytic streptococcal isolates to 24 antimicrobial drugs. Chemotherapy 43.1 (1997):10-20.</ref>


====Pediatric Outpatient====
*{{AntibioticDose|disease=Cellulitis|drug=Cephalexin|dose=25-50mg/kg/day PO divided q6-8h (max 500mg/dose)|context=Pediatric Outpatient|population=Pediatric}} '''OR'''
**Add {{AntibioticDose|disease=Cellulitis|drug=Trimethoprim-Sulfamethoxazole DS|display=TMP/SMX|dose=8-12mg/kg/day (TMP) PO divided BID|context=Pediatric Outpatient, MRSA|population=Pediatric|link=no}} if MRSA suspected
*{{AntibioticDose|disease=Cellulitis|drug=Clindamycin|dose=30-40mg/kg/day PO divided TID (max 1.8g/day)|context=Pediatric Outpatient|population=Pediatric}}


====Inpatient====
====Inpatient====
*{{AntibioticDose|disease=Cellulitis|drug=Vancomycin|dose=20mg/kg IV q12hrs|context=Inpatient}} '''OR'''
*{{AntibioticDose|disease=Cellulitis|drug=Clindamycin|dose=600mg IV q8hrs|context=Inpatient}} '''OR'''
*{{AntibioticDose|disease=Cellulitis|drug=Linezolid|dose=600mg IV q12hrs|context=Inpatient}} '''OR'''
*{{AntibioticDose|disease=Cellulitis|drug=Daptomycin|dose=4mg/kg IV once daily|context=Inpatient}}


*[[Special:MyLanguage/Vancomycin|Vancomycin]] 20mg/kg IV q12hrs '''OR'''
*[[Special:MyLanguage/Clindamycin|Clindamycin]] 600mg IV q8hrs '''OR'''
*[[Special:MyLanguage/Linezolid|Linezolid]] 600mg IV q12hrs '''OR'''
*[[Special:MyLanguage/Daptomycin|Daptomycin]] 4mg/kg IV once daily


====Pediatric Inpatient====
*{{AntibioticDose|disease=Cellulitis|drug=Vancomycin|dose=15mg/kg IV q6hrs|context=Pediatric Inpatient|population=Pediatric}} '''OR'''
*{{AntibioticDose|disease=Cellulitis|drug=Clindamycin|dose=10-13mg/kg IV q8hrs (max 900mg/dose)|context=Pediatric Inpatient|population=Pediatric}} '''OR'''
*{{AntibioticDose|disease=Cellulitis|drug=Linezolid|dose=<12yr: 10mg/kg IV q8hrs; >12yr: 600mg IV q12hrs|context=Pediatric Inpatient|population=Pediatric}}


====Saltwater related cellulitis====
====Saltwater related cellulitis====
 
*{{AntibioticDose|disease=Cellulitis|drug=Doxycycline|dose=100mg PO/IV q12hrs daily|context=Saltwater}} + [[Cefepime]] 1g IV q12hrs x 10 days
''coverage extended for [[Special:MyLanguage/Vibrio vulnificus|Vibrio vulnificus]]''
*{{AntibioticDose|disease=Cellulitis|drug=Ciprofloxacin|dose=400mg IV q12hrs x 10 days|context=Saltwater}}
*[[Special:MyLanguage/Doxycycline|Doxycycline]] 100mg PO/IV q12hrs daily + [[Special:MyLanguage/Cefepime|Cefepime]] 1g IV q12hrs x 10 days
*[[Special:MyLanguage/Ciprofloxacin|Ciprofloxacin]] 400mg IV q12hrs x 10 days
*[[Special:MyLanguage/Ciprofloxacin|Ciprofloxacin]] 750mg PO q12hrs x 10 days
 


====Freshwater related cellulitis====
====Freshwater related cellulitis====
 
*{{AntibioticDose|disease=Cellulitis|drug=Ciprofloxacin|dose=500mg PO q12hrs x 10 days|context=Freshwater}}
''coverage extended for [[Special:MyLanguage/Aeromonas sp|Aeromonas sp]]''
*{{AntibioticDose|disease=Cellulitis|drug=Trimethoprim-Sulfamethoxazole DS|display=TMP/SMX|dose=2 DS tablets PO q12hrs x 10 days|context=Freshwater}}
*[[Special:MyLanguage/Ciprofloxacin|Ciprofloxacin]] 400mg IV q12hrs  x 10 days
*{{AntibioticDose|disease=Cellulitis|drug=Ceftriaxone|dose=1g (50mg/kg) IV q24hrs|context=Freshwater}}
*[[Special:MyLanguage/Ciprofloxacin|Ciprofloxacin]] 500mg PO q12hrs x 10 days
*[[Special:MyLanguage/TMP/SMX|TMP/SMX]] 2 DS tablets (5mg/kg) PO q12hrs x 10 days
*[[Special:MyLanguage/Ceftriaxone|Ceftriaxone]] 1g (50mg/kg) IV q24hrs
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Latest revision as of 12:51, 20 March 2026

Tailor antibiotics by regional antibiogram

Outpatient

  • 5 day treatment duration
    • Cephalexin 500mg PO q6hrs OR
      • Add DS 1 tab PO BID if MRSA suspected
    • Clindamycin 450mg PO TID covers Strep and Staph


Pediatric Outpatient

  • Cephalexin 25-50mg/kg/day PO divided q6-8h (max 500mg/dose) OR
    • Add 8-12mg/kg/day (TMP) PO divided BID if MRSA suspected
  • Clindamycin 30-40mg/kg/day PO divided TID (max 1.8g/day)

Inpatient


Pediatric Inpatient

Saltwater related cellulitis

Freshwater related cellulitis

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