Cellulitis, Antibiotic Prescribing

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC). See guidance on dosing in children for quick reference dosage/weight guide. Refer to drug interactions table for detailed drug interactions for all antimicrobials. Note extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.

Note additional warnings for clarithromycin and fluoroquinolones

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.

  • 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 from Expert Advisory Committee

  • 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

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