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Last Updated: 6/26/2014  

Cellulitis and Soft Tissue Infections

Prevention
  • Prevent transmission of MRSA to patients with wounds or intravenous lines through hand hygiene and barrier precautions.

  • Prevent infection of foot ulcers in diabetic patients through routine foot care.

  • Prevent infection following human and animal bites by performing irrigation of all bites and antibiotic prophylaxis after some human, cat, and dog bites.

  • Perform active surveillance to identify patients colonized or infected by MRSA to reduce MRSA nosocomial infection rates.

Diagnosis
  • Perform a history and physical exam to detect the source of infection.

  • Use laboratory tests and cultures to document infection, judge the severity of illness, determine the cause, and guide initial and definitive antibiotic therapy.

Therapy
  • In patients with cellulitis or soft tissue infection, assess the severity of the infection and complicating comorbidities to determine the need for oral or parenteral antimicrobials.

  • Treat patients with mild, uncomplicated cellulitis who are not at high risk for MRSA with oral antibiotics that have activity against both staphylococci and streptococci; using cephalexin or dicloxacillin as first-line agents in most non-penicillin allergic patients.

  • Treat patients with mild, uncomplicated cellulitis who are at risk for MRSA infection with oral antimicrobials that have activity against MRSA and streptococci such as clindamycin, trimethoprim-sulfamethoxazole, and others.

  • Treat patients with MSSA soft tissue infections that are moderate to severe with a semisynthetic penicillin, a cephalosporin, or one of a number of other options.

  • Treat patients with moderate to severe cellulitis with systemic manifestations of infection who are at risk for MRSA with antimicrobial agents that have activity against MRSA and streptococcal infections.

  • Administer prompt antimicrobial therapy and thorough surgical debridement to patients who have evidence of gangrene.

  • Treat infections due to human and animal bites with appropriate antibiotics, starting with amoxicillin/clavulanate in outpatients receiving oral therapy.

DOI: 10.7326/d197
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Dennis L. Stevens, PhD, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Lawrence J. Eron, MD, FACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Scott Hoskinson, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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