How are adult patients categorized for the empiric treatment of cellulitis?

Updated: Apr 15, 2021
  • Author: Alfred Scott Lea, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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The empiric treatment of cellulitis in adults begins with the categorization of patients into one of the following categories:

  • Nonpurulent cellulitis: Includes rapidly spreading superficial cellulitis and erysipelas; typically involves groups A, B, C, and G beta-hemolytic streptococci and, occasionally, methicillin-susceptible Staphylococcus aureus (MSSA). These infections are diagnosed clinically, and cultures are not mandatory since there is usually no reliable and easily accessible source of specimen to culture.1234

  • Purulent cellulitis: Includes cutaneous abscesses, carbuncles, furuncles, and sebaceous cyst infection typically involving S aureus, both MSSA and methicillin-resistant S aureus (MRSA); culture should be performed when possible to determine the pathogen’s presence and resistance pattern15678

When treating nonpurulent cellulitis, typically involving beta-hemolytic streptococci and MSSA, it is unlikely that MRSA is a causative pathogen and it's coverage is not necessary.4

When treating purulent cellulitis, the initial antibiotic selection should cover MRSA for patients with coexisting penetrating and/or surgical trauma, evidence of MRSA infection elsewhere, known nasal MRSA colonization, and intravenous drug abuse. Coverage should also take into consideration the prevalence of MRSA in the patient’s hospital and community.16

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