Cellulitis

Question 1

Cellulitis?

Answer 1

• Cellulitis is a term used to describe an inflammation of the skin and subcutaneous tissues,
• due to infection by Streptococcus pyogenes or Staphylcoccus aureus.

Question 2

Features?

Answer 2

• commonly occurs on the shins
• erythema, pain, swelling
• there may be some associated systemic upset such as fever

Question 3

Criteria for admission?

Answer 3

NICE Clinical Knowledge Summaries recommend we use the Eron classification to guide how we manage patients with cellulitis:

• I - There are no signs of systemic toxicity and the person has no uncontrolled co-morbidities
• II - The person is either systemically unwell or systemically well but with a co-morbidity (for example peripheral arterial disease, chronic venous insufficiency, or morbid obesity) which may complicate or delay resolution of infection
• III - The person has significant systemic upset such as acute confusion, tachycardia, tachypnoea, hypotension, or unstable co-morbidities that may interfere with a response to treatment, or a limb-threatening infection due to vascular compromize
• IV - The person has sepsis syndrome or a severe life-threatening infection such as necrotizing fasciitis

Question 4

They recommend the following that we admit for intravenous antibiotics the following patients:

Answer 4

• Has Eron Class III or Class IV cellulitis.
• Has severe or rapidly deteriorating cellulitis (for example extensive areas of skin).
• Is very young (under 1 year of age) or frail.
• Is immunocompromized.
• Has significant lymphoedema.
• Has facial cellulitis (unless very mild) or periorbital cellulitis.

Question 5

The following is recommend regarding Eron Class II cellulitis:

Answer 5

• Admission may not be necessary if the facilities and expertise are available in the community to give intravenous antibiotics and monitor the person -
• check local guidelines.
• Other patients can be treated with oral antibiotics.

Question 6

Management?

Answer 6

• The BNF recommends flucloxacillin as first-line treatment for mild/moderate cellulitis. Clarithromycin or clindamycin is recommend in patients allergic to penicillin.
• • Many local protocols now suggest the use of oral clindamycin in patients who have failed to respond to flucloxacillin.
• • Severe cellulitis should be treated with intravenous benzylpenicillin + flucloxacillin.