Cellulitis Empiric Therapy

Cellulitis without associated purulent drainage or abscess

Outpatient treatment recommendations:

  • Dicloxacillin 500 mg PO q6h for 10-14d or
  • Cephalexin 500 mg PO q6h for 10-14d or
  • Amoxicillin-clavulanate 875 mg/125 mg PO BID for 10-14d

Inpatient treatment recommendations:

  • Cefazolin 1 g IV q8h for 1-3d

Cellulitis with purulent drainage and/or abscess

Outpatient treatment recommendations (coverage against CA-MRSA):

  • Doxycycline 100 mg PO BID for 10-14d (not for use in pregnant women or in children)
  • Clindamycin 300-600 mg PO q8h for 10-14d
  • Trimethoprim-sulfamethoxazole (160 mg/800 mg) DS 2 tabs PO BID for 10-14d

Inpatient treatment recommendations:

  • Vancomycin 15 mg/kg IV q12h for 1-3d

Empiric therapy for mammalian bite wounds

Outpatient treatment recommendations:

  • Amoxicillin-clavulanate 875 mg/125 mg PO BID for 10-14d or
  • Doxycycline 100 mg PO BID for 10-14d or
  • Cephalexin 500 mg TID for 10-14d

Inpatient treatment recommendations:

  • Ampicillin-sulbactam 3 g IV q6h for 1-3d; then transition to oral medication or
  • Cefazolin 1 g q8h for 1-3d

Diabetic foot ulcers

Outpatient treatment recommendations:

  • Clindamycin 300-600 mg PO q8h for 10-14d

Inpatient treatment recommendations:

  • Piperacillin-tazobactam 3.375 g IV q6h for 1-3d

Failure of empiric therapy
Reassess for unusual elements of history that suggest an unusual cause, such as injury in water (salt or fresh), immunocompromise, or bite wound

http://emedicine.medscape.com/article/2012280-overview