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.
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.