Cellulitis

Duration

Mild-Moderate Cellulitis: 5 days

Moderate to Severe Cellulitis/Erysipelas: IV / oral 7-14 days depending on clinical progress

Oral Flucloxacillin⁵500mg - 1g 6 hourly

Penicillin allergy
Oral Doxycycline^{2, 9}100mg 12 hourly
OR
Oral Co-trimoxazole ^2,10,12,13960mg 12 hourly

Total duration:5 days

IV Flucloxacillin^{5, 10} 1-2g 6 hourly

Stepping down to:
Oral Flucloxacillin 1g 6 hourly

Penicillin allergy or MRSA suspected
IV Vancomycin³

Stepping down to:
Oral Doxycycline^2,9 100mg 12 hourly

For upper limb cellulitis seek advice from Orthopaedics

Total duration: IV / oral 7-14 days depending on clinical progress

Doses may need to be adjusted in renal impairment. Always check the BNF for interactions. Seek advice if patient pregnant.

Drug Specific Cautions:

Check interactions in the BNF. Caution may prolong QT interval.
Avoid / Caution in pregnancy or breastfeeding. Consult BNF for details.
Gentamicin/Vancomycin refer to online calculators.
ALERT Antibiotic - Consult Second line Policy on NHS Lanarkshire Guideline App.
Monitor sodium.
See CURB65 definition.
Reference: The Renal Drug Handbook. Online access.
See Fluoroquinolones MHRA guidance on NHS Lanarkshire Guidelines App.
Doxycycline and quinolones decreased absorption with iron, calcium, magnesium and some nutritional supplements. See BNF appendix 1 or pharmacy for advice.
Caution in renal impairment – see BNF or pharmacy for advice.
Use with caution may increase K+ and decrease renal function. Monitor.
High / Excellent oral bioavailability, IV route available for NBM or vomiting.
See Co-trimoxazole information for prescribers’ safety sheet on NHS Lanarkshire Guidelines App.

Last reviewed: 01/12/2022

Next review date: 01/12/2025

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick.

Approved By: NHS Lanarkshire Antimicrobial Management Committee

Reviewer name(s): NHS Lanarkshire Antimicrobial Management Committee.

Document Id: March 2023