Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

Purulent Cellulitis

Empiric Therapy

I&D if indicated

Please send deep tissue cultures at the time of surgical debridement

PLUS EITHER

Vancomycin 15 mg/kg Q8-12h

  • Loading dose of 20 mg/kg once is recommended

  • Q8h dosing is preferred in young adults

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

TMP-SMZ 1-2 DS tabs PO Q12h

OR

Doxy/Minocycline 100mg PO Q12h

OR

Clindamycin 300-450mg Q6-8h

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