Module 9 Part 2 Cellulitis – Severe

Question 1

What are the probable organisms causing severe cellulitis (non-facial)?

Answer 1

Staphylococcus aureus, Group A Streptococcus, Group C Streptococcus, Group G Streptococcus, and Group F Streptococcus.

Question 2

What is the first-line treatment for severe cellulitis?

Answer 2

Cefazolin (IV) at 1-2 g q8h for adults and 100 mg/kg/day divided q8h for children.

Question 3

What is the second-line treatment for severe cellulitis?

Answer 3

Amoxicillin/Clavulanate at 500 mg TID or 875 mg BID for adults, and 40 mg/kg/day amoxicillin divided q8h for children.

Question 4

When should empiric coverage for community-acquired methicillin-resistant S. aureus (CA-MRSA) be considered in severe cellulitis cases?

Answer 4

It should be considered in areas where MRSA is common (>10-15% of S. aureus) or in patients with certain risk factors.

Question 5

What antibiotics are active against CA-MRSA in severe cellulitis cases?

Answer 5

TMP/SMX and doxycycline.

Question 6

What is the third-line treatment for severe cellulitis?

Answer 6

Ceftriaxone (IV) at 1-2 g q24h for adults, and for children, 75 mg/kg/day divided q12h-q24h (maximum: 2 g/day). Clindamycin (IV) at 3600 mg q8h. Metronidazole (IV) at 3500 mg q12h.