Cellulitis Not Improving After Oral Antibiotic Therapy — Next-Line Management
Oral antimicrobial treatment is the standard first approach to cellulitis. When it does not produce clinical improvement within the expected timeframe, a structured escalation is indicated.
Why this protocol applies: Oral antimicrobial therapy active against streptococci — such as oral penicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, cephalexin, or clindamycin — was used as initial treatment. The target of clinical improvement within 5 days was not achieved. This protocol addresses the recommended next step.
Next-Line Approach
Escalation to systemic intravenous antibiotics with activity against streptococci is indicated. The full protocol specifies which agents to consider, when broader staphylococcal coverage may be appropriate, and how to assess response — details not shown here.
Treatment goal: Clinical improvement of the cellulitis within 5 days of starting the next-line therapy.
References
DOI: 10.1093/cid/ciu296
- For cellulitis with systemic signs of infection (moderate nonpurulent SSTI; Figure 1) systemic antibiotics are indicated.
- Many clinicians could include coverage against MSSA (weak, low).
- 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).