When should IV antibiotic therapy be considered for cellulitis and how is the antibiotic selected?

Updated: Jun 14, 2019
  • Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Severely ill patients and those whose condition is unresponsive to standard oral antibiotic therapy should be treated with inpatient intravenous (IV) antibiotics. The selection of antibiotic therapy should be based on suspicion for likely organisms as well as results of Gram stain, culture, and drug susceptibility analysis, if available. [2]

In hospitalized patients in which S aureus infection is a concern, it is wise to assume methicillin (oxacillin) resistance because of the high prevalence of community-acquired methicillin-resistant strains (CA-MRSA); administer agents that are usually effective against MRSA, such as vancomycin, linezolid, ceftaroline, or daptomycin. [2] Step-down treatment for S aureus– related soft-tissue infections may focus upon tetracyclines, trimethoprim-sulfamethoxazole, or other agents, depending on the results of susceptibility tests and following an initial clinical response.

Other individuals who may require inpatient IV antibiotic include the following [8] :

  • Immunosuppressed patients

  • Patients with facial cellulitis

  • Any patient with a clinically significant concurrent condition, including lymphedema and cardiac, hepatic, or renal failure

  • Individuals with newly elevated creatinine, creatine phosphokinase, and/or low serum bicarbonate levels or marked left-shift polymorphonuclear neutrophils


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