Cellulitis - Antibiotic Prescribing

Safe Prescribing (visit the safe prescribing page)


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
  • Suspected infection in the foot of a diabetic patient is considered a clinical emergency due to vascular compromise and risk of osteomyelitis . The patient should have a same day urgent referral to secondary care for assessment and treatment
  • In facial cellulitis use co-amoxiclav.
  • Note: recurrent cellulitis should be managed differently. See Leg Ulcers and recurrent cellulitis
  • Aim to identify and modify risk factors for recurrent infections e.g. Diabetes mellitus, poor circulation, tinea infection, immunosuppression.
  • 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.

Treatment

Cellulitis 2020 table image

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

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.

Reviewed Feb 2020