Cellulitis Not Improving After Initial IV Antibiotic Therapy

When systemic intravenous antibiotic therapy for cellulitis — targeting streptococci with or without additional coverage against methicillin-susceptible Staphylococcus aureus — does not produce clinical improvement within 5 days, escalation to a broader empiric regimen is indicated.

Previous Treatment — Failure Condition

First-line therapy consists of systemic IV antibiotics targeting streptococci (e.g., penicillin, cefazolin, or clindamycin), optionally with added MSSA coverage. Escalation to this protocol is triggered when clinical improvement of the cellulitis is not observed within 5 days of starting that regimen.

Next-Line Approach

This protocol employs a broad-spectrum empiric intravenous regimen that combines agents covering a wider range of pathogens, including resistant organisms. The specific combination and full dosing structure are available in the complete protocol.

Treatment Goal

Clinical improvement of the cellulitis within 5 days of starting the escalated regimen.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/cid/ciu296

In severely compromised patients (as defined in question 13), broad-spectrum antimicrobial coverage may be considered (weak, moderate).
Vancomycin plus either piperacillin-tazobactam or imipenem-meropenem is recommended as a reasonable empiric regimen for severe infection (strong, moderate).
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).

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