Cellulitis: Difference between revisions
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According to the 2005 clinical practice guidelines, which state that [[staphylococcus aureus]] is very uncommon: "Suitable agents include [[dicloxacillin]], [[cephalexin]], [[clindamycin]], or [[erythromycin]], unless streptococci or staphylococci resistant to these agents are common in the community."<ref name="pmid16231249">{{cite journal |author=Stevens DL, Bisno AL, Chambers HF, ''et al.'' |title=Practice guidelines for the diagnosis and management of skin and soft-tissue infections |journal=Clin. Infect. Dis. |volume=41 |issue=10 |pages=1373–406 |year=2005 |month=November |pmid=16231249 |doi=10.1086/497143 |url=http://www.journals.uchicago.edu/cgi-bin/resolve?CID37519 |issn=}}</ref> | According to the 2005 clinical practice guidelines, which state that [[staphylococcus aureus]] is very uncommon: "Suitable agents include [[dicloxacillin]], [[cephalexin]], [[clindamycin]], or [[erythromycin]], unless streptococci or staphylococci resistant to these agents are common in the community."<ref name="pmid16231249">{{cite journal |author=Stevens DL, Bisno AL, Chambers HF, ''et al.'' |title=Practice guidelines for the diagnosis and management of skin and soft-tissue infections |journal=Clin. Infect. Dis. |volume=41 |issue=10 |pages=1373–406 |year=2005 |month=November |pmid=16231249 |doi=10.1086/497143 |url=http://www.journals.uchicago.edu/cgi-bin/resolve?CID37519 |issn=}}</ref> | ||
A study of failed treatment concluded that failure is reduced if:<ref name="pmid22445732">{{cite journal| author=Halilovic J, Heintz BH, Brown J| title=Risk factors for clinical failure in patients hospitalized with cellulitis and cutaneous abscess. | journal=J Infect | year= 2012 | volume= | issue= | pages= | pmid=22445732 | doi=10.1016/j.jinf.2012.03.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22445732 }} </ref> | |||
* Higher dose antibiotics are used: | |||
** [[vancomycin]] at least 30 mg/kg/day | |||
** [[clindamycin]] at least 10 mg/kg/day (450 mg every 8 hours) | |||
** [[Trimethoprim-Sulfamethoxazole combination]] at least 5 mg/kg/day of trimethoprim (a single strength pill has 80 mg trimethoprim) (two double strength pills every 12 hours) | |||
If both [[Methicillin resistant Staphylococcus aureus]] and [[Streptococcus pyogenes]] are possible causes, then "options include the following: clindamycin alone (A-II) or TMP-SMX or a tetracycline in combination with a β-lactam (eg, amoxicillin) (A-II) or linezolid alone (A-II)."<ref name="pmid21217178">{{cite journal| author=Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ et al.| title=Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 3 | pages= 285-92 | pmid=21217178 | doi=10.1093/cid/cir034 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21217178 }} </ref> | |||
If [[levofloxacin]] is used for treatment, 5 days is as effective as 10 days.<ref name="pmid15302637">{{Cite journal | doi = 10.1001/archinte.164.15.1669 | issn = 0003-9926 | volume = 164 | issue = 15 | If [[levofloxacin]] is used for treatment, 5 days is as effective as 10 days.<ref name="pmid15302637">{{Cite journal | doi = 10.1001/archinte.164.15.1669 | issn = 0003-9926 | volume = 164 | issue = 15 | ||
Revision as of 22:29, 14 May 2012
Cellulitis is "an acute, diffuse, and suppurative inflammation of loose connective tissue, particularly the deep subcutaneous tissues, and sometimes muscle, which is most commonly seen as a result of infection of a wound, ulcer, or other skin lesions." [1] The condition has been known from antiquity; generations of medical students learned its signs as rubor, tumor, calor, dolor or "reddened, swollen, warm to the touch, and painful." The presence of broken skin in the inflamed area is a further warning, but there may be no obvious wound.
The most common organisms are:[2]
- Staphylococcus aureus
- Streptococcus pyogenes (group A strept)
One study found that about 75% of cases are due to Streptococcus pyogenes and that beta-lactam antibiotics ineffective against MRSA are effective for cellulitis.[3]
Differential diagnosis to rule out life-threatening conditions, such as deep venous thrombosis, compartment syndrome and gangrene, is essential; a presentation of the common signs of cellulitis needs urgent, if not emergent, evaluation.
Treatment
According to the 2005 clinical practice guidelines, which state that staphylococcus aureus is very uncommon: "Suitable agents include dicloxacillin, cephalexin, clindamycin, or erythromycin, unless streptococci or staphylococci resistant to these agents are common in the community."[4]
A study of failed treatment concluded that failure is reduced if:[5]
- Higher dose antibiotics are used:
- vancomycin at least 30 mg/kg/day
- clindamycin at least 10 mg/kg/day (450 mg every 8 hours)
- Trimethoprim-Sulfamethoxazole combination at least 5 mg/kg/day of trimethoprim (a single strength pill has 80 mg trimethoprim) (two double strength pills every 12 hours)
If both Methicillin resistant Staphylococcus aureus and Streptococcus pyogenes are possible causes, then "options include the following: clindamycin alone (A-II) or TMP-SMX or a tetracycline in combination with a β-lactam (eg, amoxicillin) (A-II) or linezolid alone (A-II)."[6]
If levofloxacin is used for treatment, 5 days is as effective as 10 days.[7] However, levoflaxacin is ineffective against methicillin-resistant Staphylococcus aureus.
References
- ↑ Anonymous (2024), Cellulitis (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Chira, S; L G Miller (2009-08-03). "Staphylococcus aureus is the most common identified cause of cellulitis: a systematic review". Epidemiology and Infection: 1-5. DOI:10.1017/S0950268809990483. ISSN 0950-2688. PMID 19646308. Retrieved on 2009-09-01. Research Blogging.
- ↑ Jeng A, Beheshti M, Li J, Nathan R (2010). "The role of beta-hemolytic streptococci in causing diffuse, nonculturable cellulitis: a prospective investigation.". Medicine (Baltimore) 89 (4): 217-26. DOI:10.1097/MD.0b013e3181e8d635. PMID 20616661. Research Blogging.
- ↑ Stevens DL, Bisno AL, Chambers HF, et al. (November 2005). "Practice guidelines for the diagnosis and management of skin and soft-tissue infections". Clin. Infect. Dis. 41 (10): 1373–406. DOI:10.1086/497143. PMID 16231249. Research Blogging.
- ↑ Halilovic J, Heintz BH, Brown J (2012). "Risk factors for clinical failure in patients hospitalized with cellulitis and cutaneous abscess.". J Infect. DOI:10.1016/j.jinf.2012.03.013. PMID 22445732. Research Blogging.
- ↑ Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ et al. (2011). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary.". Clin Infect Dis 52 (3): 285-92. DOI:10.1093/cid/cir034. PMID 21217178. Research Blogging.
- ↑ Hepburn, Matthew J; David P Dooley, Peter J Skidmore, Michael W Ellis, William F Starnes, William C Hasewinkle (2004-08-09). "Comparison of short-course (5 days) and standard (10 days) treatment for uncomplicated cellulitis". Archives of Internal Medicine 164 (15): 1669-1674. DOI:10.1001/archinte.164.15.1669. ISSN 0003-9926. PMID 15302637. Retrieved on 2009-09-01. Research Blogging.