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Cellulitis (non-purulent)/Erysipelas
Outpatient Treatment

Outpatient Treatment

Clinical Considerations

Patients with lower extremity cellulitis should keep the affected limb elevated above the heart as often as possible

Treat tinea pedis if present

Clinical Course

  • Non-purulent cellulitis often gets worse before it gets better
  • It can take 48-72 hr to see visible improvement in margins
  • Patients should be instructed to return if they feel subjectively worse (i.e worsening fever, chills, malaise, pain, etc..)
  • Expect discoloration (post-inflammatory hyperpigmentation) to persist even after patients have been successfully treated with an adequate course of antibiotics

Duration of Therapy

  • 5 days
  • Consider 7-10 days if morbidly obese, large area of cellulitis, or if follow-up is not available

Mild-Mod Penicillin Allergy or Intolerance

Cefuroxime 500 mg PO BID
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  • Note: non-formulary for inpatient/ED use.
  • Prescribe for outpatient use only.

Life-Threatening Penicillin and/or Ceph Allergy

Clindamycin 300 mg PO QID
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Consider 450 mg QID if wt > 120 kg

MRSA Coverage

Consider adding MRSA coverage if the following are present:

  • MRSA infection elsewhere
  • IVDU
  • Cellulitis overlying hardware or medical device
  • Failure to respond to > 48 hr oral B-lactam therapy
  • H/o MRSA infection

OR

Bactrim DS 1-2 tab PO BID
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Consider 2 tabs BID if wt >120 kg