Specific clinical features signal a substantially elevated likelihood of MRSA involvement in cellulitis. When any of these risk factors is present, the antimicrobial approach must be adjusted accordingly.
This protocol applies when cellulitis occurs in the presence of one or more of the following:
When one or more of these MRSA risk factors is present, antimicrobial therapy with activity against both MRSA and streptococci is recommended. The full protocol specifies which agents qualify and guides complete regimen selection.
Clinical improvement of the cellulitis within 5 days of starting therapy.
DOI: 10.1093/cid/ciu296
For patients whose cellulitis is associated with penetrating trauma, evidence of MRSA infection elsewhere, nasal colonization with MRSA, injection drug use, purulent drainage, or SIRS (severe nonpurulent), vancomycin or another antimicrobial effective against both MRSA and streptococci is recommended (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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