Cellulitis Organism-Specific Therapy
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Organism-specific therapeutic regimens for cellulitis are provided below, including those for group A beta-hemolytic streptococci (GABHS) [1] and community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). [2, 3, 4, 5, 6, 7]
The Infectious Diseases Society of America (IDSA) published 2014 guidelines for the treatment of cellulitis (see Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America). [8]
Outpatient treatment recommendations:
Inpatient treatment recommendations:
Outpatient treatment recommendations:
Inpatient treatment recommendations:
In June 2017, the FDA approved delafloxacin (Baxdela) for the treatment of acute bacterial skin and skin structure infections (ABSSSI). Baxdela exhibits activity against both gram-positive and gram-negative pathogens, including MRSA and is available in both intravenous (IV) and oral formulations. [9]
Recommended dose:
Elevation of the affected extremity may speed resolution.
Consider surgical consultation in the following cases:
Urgent consultation with a surgeon should be sought in the setting of crepitus, circumferential cellulitis, necrotic-appearing skin, rapidly evolving cellulitis, pain disproportional to physical examination findings, severe pain on passive movement, or other findings that raise clinical concern for necrotizing fasciitis
Serious concern for necrotizing fasciitis or the presence of necrotic skin should prompt examination of the fascial planes by direct observation; this can be performed at the bedside by an experienced surgeon in most cases
Circumferential cellulitis may result in compartment syndrome, and surgical decompression may be necessary; measurement of compartment pressures may be helpful in diagnosis
Cellulitis associated with an abscess requires surgical drainage of the source of infection for adequate treatment
[Guideline] Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. 2005 Nov 15. 41(10):1373-406. [Medline].
King MD, Humphrey BJ, Wang YF, Kourbatova EV, Ray SM, Blumberg HM. Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med. Mar 7 2006. 144(5):309-17.
Daum RS. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. N Engl J Med. Jul 26 2007. 357(4):380-90.
Stryjewski ME, Chambers HF. Skin and soft-tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2008 Jun 1. 46 Suppl 5:S368-77. [Medline].
Shoji K, Shinjoh M, Horikoshi Y, Tang J, Watanabe Y, Sugita K, et al. High rate of inducible clindamycin resistance in Staphylococcus aureus isolates – A multicenter study in Tokyo, Japan. J Infect Chemother. 2014 Oct 31. [Medline].
Lévesque S, Bourgault AM, Galarneau LA, Moisan D, Doualla-Bell F, Tremblay C. Molecular epidemiology and antimicrobial susceptibility profiles of methicillin-resistant Staphylococcus aureus blood culture isolates: results of the Quebec Provincial Surveillance Programme. Epidemiol Infect. 2014 Aug 20. 1-8. [Medline].
Cunha BA. Minocycline, often forgotten but preferred to trimethoprim-sulfamethoxazole or doxycycline for the treatment of community-acquired meticillin-resistant Staphylococcus aureus skin and soft-tissue infections. Int J Antimicrob Agents. 2013 Dec. 42(6):497-9. [Medline].
[Guideline] Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, 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 Jul 15. 59(2):e10-52. [Medline].
Baxdela (delafloxacin) [package insert]. 300 Tri-State International Lincolnshire, Illinois, USA: Melinta Therapeutics, Inc. 6/2017. Available at [Full Text].
Alfred Scott Lea, MD Associate Professor of Medicine, Department of Medicine, Division of Infectious Diseases, University of Texas Medical Branch School of Medicine
Alfred Scott Lea, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, Infectious Diseases Society of America, Texas Medical Association, Harris County Medical Society, American College of Certified Wound Specialists
Disclosure: Nothing to disclose.
George Samuel, MDCM, MSc Fellow in Infectious Diseases, University of Texas Medical Branch School of Medicine
George Samuel, MDCM, MSc is a member of the following medical societies: American College of Physicians, American Society for Microbiology
Disclosure: Nothing to disclose.
Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.
Eric S Halsey, MD Head, Virology Department, Naval Medical Research Unit No. 6, Lima, Peru; Assistant Professor of Medicine, Uniformed Services University of the Health Sciences
Eric S Halsey, MD is a member of the following medical societies: Armed Forces Infectious Diseases Society, HIV Medicine Association of America, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.
Isaac P Humphrey, MD Assistant Professor of Internal Medicine, Uniformed Services University of the Health Sciences; Clinical Assistant Professor of Internal Medicine, Wright State University Boonshoft School of Medicine
Isaac P Humphrey, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.
Cellulitis Organism-Specific Therapy
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