Criteria & Principles
Patients with purulent cellulitis (e.g. cellulitis associated with purulent drainage or exudate, in the absence of a drainable abscess) should be managed with empiric therapy for infection due to MRSA.
For immunocompromised patients, consider tissue biopsy for routine, fungal and AFB cultures.
REASSESS AT 48-72 HOURS AND ADJUST THERAPY (BASED ON CULTURE/SUSCEPTIBILITY RESULTS) ACCORDINGLY
Treatment
Severity
Mild-Moderate
Mild infection: typical cellulitis with purulence
- Incision & Drainage
Moderate infection: patients with purulent infection with systemic signs of infection
- Incision & drainage and culture & suceptibility
- Trimethoprim-sulfamethoxazole 2 DS tablet PO BID, OR
- Doxycycline 100 mg PO BID
Severe
Severe infection: patients who have failed I&D plus oral antibiotics, those with systemic signs of infection, or immunocompromised patients
- Vancomycin loading dose + maintenance dose, OR
- Daptomycin 6 mg/kg IV q24h (ID Consult required), OR
- Linezolid 600 mg IV/PO q12h
Add Gram negative and anaerobic coverage if severe sepsis or septic shock.
Diagnosis-Specific Information
Table. Comparing anti-MRSA therapy (vancomycin and linezolid)
References
Stevens DL, et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59: e10-52.