Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

Non-Purulent Cellulitis

Empiric Antimicrobial Therapy

Nafcillin 1-2G IV Q4h

Use 2G if weight >80kg

OR

Cefazolin 1-2G IV Q8h

Use 2G if weight >80kg

OR

Ceftriaxone 1-2G IV Q24h

Use 2G if weight >80kg

OR

Clindamycin 600-900mg IV Q8h

Alternative (including for patients with severe penicillin allergy i.e. anaphylaxis, angioedema, hives, etc.)

De-escalate To PO Antibiotics

De-escalation should occur when fever subsides and signs and symptoms of skin infection improve

De-escalation Options

Dicloxacillin 500mg PO Q6h

OR

Cephalexin 500mg PO Q6h

OR

Clindamycin 300-450mg PO Q6-8h

Alternative (including for patients with severe penicillin allergy i.e. anaphylaxis, angioedema, hives, etc.)

Duration

The total duration of therapy for uncomplicated cellulitis is 7 days

Longer duration may be required in complicated cases (deep abscesses or necrotizing infections) and depending on clinical response