Cellulitis medical therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aditya Govindvarjhulla, M.B.B.S.
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Overview
Antibiotics - typically a combination of intravenous and oral antibiotics are administered. Bed rest and elevation of affected limbs is also recommended. In patients with edema of extremities which is a risk factor again, in such cases compressive stockings may really aid in our treatment. For abscess which are small and unaffecting the surrounding tissue can be treated with simple incision and drainage. Drink plenty of fluids as well - at least 8 glasses of water a day.
Medical Therapy
Antibiotics are the mainstay of treatment of medical therapy. Primary aim of the physician for using antibiotics is to
- Treatment of the infection.
- Prevent complications.
- Reduce hospital stay or morbidity.
Choice of antibiotic therapy depends on few factors.
- Age of the individual
- Co-morbid conditions
- Site of lesion
- Severity of lesion
- Pathogen involved(gram positive or negative/aerobic or anaerobic)
- Strain and resistance of the pathogen
Most common causative pathogen is Staphylococcus aureus ,a gram positive bacteria. This is empirically treated with Beta-lactum antibiotics. Nowadays latest reports suggest that this bacterium has acquired resistance(MRSA) and newer drugs are to be used.Reports from the laboratory regarding sensitivity of the pathogen is key factor in deciding the therapy.
Uncomplicated Cellulitis
- In cases of simple infection without abscess or draining Dicloxacillin, Amoxacillin or first generation cephalosporins like Cephalexin are used.
- Patients allergic to penicillin drugs can be administered with macrolide antibiotics like azithromycin.
- A notion of giving a parenteral shot of antibiotic and then oral medication to cover the lag period of oral one.
Severe Cellulitis
- In severe cases parenteral therapy is advocated.
- Higher generation of cephalosporins like Ceftrioxone,Cefuroxime are used.
- Penicillin allergic individuals can be given Vancomycin / Clindamycin.
- In diabetic individuals broad coverage antibiotics are used. Diabetics are prone to infections to empiric therapy include drugs covering gram positive/negative & anaerobic bacteria.