Cellulitis

Organisms S. pyogenes. S. aureus.  Panton-Valentine Leucocidin toxin is produced by 2% of S.aureus and produces recurrent abcesses or cellulitis.  Risk factors include young age, patients in close communities, contact sportsmen and possibly travel abroad.  Consider swabbing for PVL if recurrent boils or abcesses.  If swab taken add '?PVL' on clinical details.
Treatment
1st line Flucloxacillin 1g four times daily for 7 days.  
   
Penicillin allergy or risk of MRSA Doxycycline 100mg twice daily (7 days).
   
  If history or risk of MRSA check sensitivities and start antibiotics and adjust in line with sensitivities.  If no improvement seek ID/Microbiology advice.  Details on decolonisation programme can be obtained from Infection Prevention and Control -  click here (refer to Section 2 MRSA - Appendix 6 (decolonisation regimen).
   
Referral If systemically unwell or not responding refer to hospital as parenteral antibiotic therapy may be required. Intravenous antibiotics are available on an out-patient basis from the Infectious Diseases Unit in some cases.
Notes: 
The use of antibiotics in the treatment of leg ulcers is only recommended with clear evidence of clinical infection (pain, cellulitis, fever, progressing infection), refer to the Management of  Chronic Venous Leg Ulcers SIGN publication No 120 and NHS Tayside Management of suspected infection in chronic wounds and ulcers

 

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