Cellulitis
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A suppurative bacterial infection of the skin and soft tissue, often with involvement of underlying structures: fascia, muscles, and tendons
Causes
- Mostly caused by Staphylococcus aureus and Streptococcus pyogenes
- Less common causes include anaerobic bacteria, mycobacteria, proteus, pseudomonas
Signs and symptoms
- Growing redness and swelling of affected area, with pitting
- Fever
- Painful, enlarged regional lymph nodes
- Systemic signs of toxicity
Differential diagnosis
- Erysipelas
- Deep vein thrombosis
Investigations
- Blood culture and susceptibility tests
- Full blood count with differentials
- Fasting blood glucose
- HIV screening
Treatment objectives
- Eradicate infection
- Treat underlying cause(s) of immunosuppression if present
- Prevent complications
Non-pharmacological/pharmacological treatment
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- Cold compresses - Elevation and rest of the affected limb to reduce pain and local swelling - Apply saline wet dressings to ulcerated and necrotic lesions every 12 hours - Debridement of the necrotic lesions First line Treatment Penicillin V oral Adult: 250mg oral every 6 hours for 5-7days Child: 125-250mg every 6 hours for 5-7days Note: Should be taken on an empty stomach OR Flucloxacillin oral Adult: 250-500 mg every 6 hours for 7 days Child: 5-12 years: 250 mg every 6 hours for 7 days 1-5 years: 125 mg every 6 hours for 7 days <1 year: 62.5 mg every 6 hours for 7 days In patients allergic to penicillin: Erythromycin oral Adult: 500mg four times a day for 7-10 days. Child: Up to 2 years 125mg 2 – 8 years: 250mg for 5 days For pain give Paracetamol oral Adult: 1 g three to four times a day as required Child: < 3 years: 125 mg every 6-8 hours > 3 years: 250mg every 6-8 hours |
Referral
- Refer patient to dermatologist if no improvement