This protocol applies to patients with erysipelas or cellulitis who present without systemic signs of infection — no fever, no hemodynamic instability, and no evidence of severe systemic spread.
The absence of systemic signs places these cases in a mild category. Typical cases of cellulitis without systemic signs should receive an antimicrobial agent active against streptococci.
The approach centres on oral antimicrobial therapy specifically targeted against streptococci, delivered over a short, defined course. A large proportion of patients in this category can be managed entirely with oral agents from the outset.
Adjunctive measures — including elevation of the affected area and addressing predisposing local factors — are part of the recommended approach. The complete regimen, including antibiotic selection, sequencing, and conditions for additional adjuncts, is available in the full protocol.
Clinical improvement of the infection within 5 days of starting treatment. If improvement has not occurred within that window, the treatment course should be extended accordingly.
DOI: 10.1093/cid/ciu296