Cellulitis

Note Panton-Valentine Leukocidin (PVL) is a toxin produced by 2% of Staphylococcus aureus and is associated with persistent recurrent pustules and carbuncles or cellulitis. Send swabs for culture in these clinical scenarios. On rare occasions it causes more severe invasive infections, even in otherwise fit people. Risk factors include: nursing homes, contact sports, sharing equipment, poor hygiene and eczema.

NoteDoses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Board website or the printed Irish Medicines Formulary for drug SPCs, dosage, contraindications, interactions, or IMF/BNF/BNFC/MIMS. See guidance on dosing in children for quick reference dosage/weight guide.

Letters indicate strength of evidence range from A+ (systematic review) to D (informal opinion). Statins can interact with some antibiotics and increase the risk of rhabdomyolysis. Amiodarone and drugs which prolong the QT interval can interact with many antibiotics. Many antibiotics increase the risk of bleeding with anticoagulants. Please refer to our Drug Interactions Table for further information.

  • If patient afebrile and otherwise healthy, flucloxacillin may be used as single drug treatment. If water exposure, discuss with microbiologist.
  • If febrile and ill, admit for IV treatment.
  • In facial cellulitis use co-amoxiclav.C

Comments

  • If patient afebrile and otherwise healthy, flucloxacillin may be used as single drug treatment. If water exposure, discuss with microbiologist.
  • If febrile and ill, admit for IV treatment.
  • In facial cellulitis use co-amoxiclav.C

Treatment

See guidance on dosing in children for quick reference dosage/weight guide.

Treatment Dose TX Duration
flucloxacillin See flucloxacillin dosing for children 7 - 14 days
If penicillin allergic: clarithromycin
OR
clindamycin (risk of Clostridium difficile)

See clarithromycin dosing for children

450mg QDS
7 - 14 days
Facial cellulitis: co-amoxiclav 625 mg TDS 7 - 14 days

Note recurrent cellulitis should be managed differently
See leg ulcers and recurrent cellulitis for details.

We recommend patients use the website developed by HSE/ICGP/IPU partnership www.undertheweather.ie for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.

The HSE Health A-Z website provides patient information on many hundreds of conditions and treatments.

Click here to view information on Cellulitis

Reviewed June 2016