Cellulitis (Bacterial Skin infection)

Question 1

Background

Answer 1

Term used to show non-necrotising inflammation of the skin and subcutaneous tissues.

Question 2

Signs and Symptoms / Diagnosis

Answer 2

localised pain, swelling, tenderness, erythema, warmth, oedema. Fever, malaise, nausea, and rigor (severe chills).

Underlying causes
Diabetes, immunodeficiency, cancer, venous stasis, chronic liver disease, peripheral arterial disease and CKD.

Diagnosis
History, examination, Swabs if open wound, drainage, obvious portal for microbial entry. WCC or skin biopsy possible too.

Question 3

Treatment

Answer 3

Mostly done outpatient setting. If fail then hospital.
If there is a abcess drainage usually resolves infection if abcess is isolated.
if fail Antibiotics needed.

CKS/BNF:
Swab. And draw around infected area to monitor disease progression.
Class 1 cellulitis (no signs of systemic toxicity and no uncontrolled comorbidities).
1st line ORAL or IV:
- Flucoxacillin 500-1000mg QDS 5-7days.
ALT:
Clarithromycin 500mg BD 5–7 days.
Doxycycline 200mg on the first day then 100 mg OD, 5–7 days.
Erythromycin (in pregnancy) 500mg QDS 5–7 days.

1st line ORAL or IV if near eyes/nose:
- co-amoxiclav 500/125mg TDS 7 days
ALT:
- Clarithromycin 500mg BD 5–7 days + metronidazole 400mg TDS 7 days.

Severe infection:
Oral or IV:
- Co-amoxiclav, clindamycin, IV cefuroxime, or IV ceftriaxone (ambulatory care only).
- MRSA sus/confirmed + IV vancomycin, IV teicoplanin or linezolid.

Recurrent Infection:
REFER

Reassessment:
Reassess if symptoms worsen 2- 3 days after treatment start or Patient becomes systemically unwell. Or if Swab results come back showing better antibiotics.

Question 4

Treatment for surgical infection site

Answer 4

PRE OP
Mupirocin + Chlorohexidine
M - Nasal c - body wash

Op
1st line
Chlorhexidine alcohol-based solution (unless contraindicated or surgery site next to mucous membrane)
ALT aqueous solution chlorhexidine if site next to mucous membrane

2nd line
chlorhexidine contraindicated:
Povidone iodine alcohol based
ALT if can’t alcohol based – aqueous solution povidone iodine.

Post op
If cellulitis sus give appropriate antibiotics

Question 5

Drug contraindication/ AE

Answer 5

Amoxicillin:
Contraindicated - allergey to penicillin or cephalosporin
AE - Skin rash diarrhoea N, V

Clarithromycin: (macrolide)
Contraindicated: Severe hepatic impairment, hypokalaemia, Hx QT prolongation or ventricular arrhythmia, P or BF unless benefit outweighs
AE - larges doses - reversible hearing loss.

Co-amoxiclav:
Contraindicated- allergy to penicillin or cephalosporin
AE - GI, nervous, skin,

Doxycycline: (tetracycline)
Contraindicated - P or BF and <12 yrs
AE - dyspnoea, peripheral oedema, hypotension

Erythromycin:
Contraindicated - acute porphyrias, medicines that interact with erythromycin (for example, simvastatin, mizolastine, domperidone, cisapride, pimozide, ergotamine, dihydroergotamine), Hx QT interval prolongation or ventricular arrhythmia.
AE - GI, CV, skin, heptaobillary

Flucoxacillin:
Contraindicated - alleregy to pencillin or cephalosporin. HX penicillin-associated jaundice or hepatic dysfunction.
AE - Thrombocytopenia, diarrhoea, skin rash etc. Hepatitis and cholestatic jaundice, Anaphylaxis

Metronidazole:
Contraindicated - allergey
AE - Blood disorders (Thrombocytopenia etc)
GI (N,V, etc)
Nervous (drowsiness, dizziness)
Skin
Psychiatric