What Is the First-Line Treatment of Cellulitis Without Systemic Signs of Infection?
Typical cellulitis presenting without systemic signs of infection is managed with a structured oral antimicrobial regimen. Appropriate early treatment aims for measurable clinical improvement within 5 days.
Adult patient with typical cellulitis, no systemic signs of infection, suitable for outpatient oral therapy.
First-line management centres on an oral antimicrobial agent with reliable activity against streptococci, combined with supportive local measures. In certain patients, an adjunctive intervention may also be appropriate. The complete agent selection, criteria for duration extension, and full regimen detail are in the structured protocol.
Clinical improvement of the cellulitis within 5 days of starting therapy; duration is extended if improvement is not yet achieved at that point.
References
DOI: 10.1093/cid/ciu296
- Typical cases of cellulitis without systemic signs of infection should receive an antimicrobial agent that is active against streptococci (mild; Figure 1) (strong, moderate).
- Therapy for typical cases of cellulitis should include an antibiotic active against streptococci (Table 2).
- A large percentage of patients can receive oral medications from the start for typical cellulitis, and suitable antibiotics for most patients include penicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, cephalexin, or clindamycin.
- The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period (strong, high).
- Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended (strong, moderate).
- Systemic corticosteroids (eg, prednisone 40 mg daily for 7 days) could be considered in nondiabetic adult patients with cellulitis (weak, moderate).