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Therapeutic Approach

Cellulitis is a bacterial soft tissue infection involving the deep dermis and subcutaneous tissue, typically affecting the lower limbs. Erysipelas is a superficial variant of cellulitis, affecting the upper dermis with accompanying lymphangitis. Therapy targeting both group A beta-hemolytic streptococci (GAS) and Staphylococcus Aureas is necessary for cellulitis, while therapy targeting GAS alone in clear-cut cases of erysipelas is typically sufficient. Ten percent to 30% of patients diagnosed with cellulitis experience recurring episodes, and there is increasing evidence for antimicrobial prophylaxis preventing cellulitis recurrence. Therapeutic options for outpatient management of uncomplicated cellulitis and erysipelas are outlined below. For uncomplicated cellulitis and erysipelas, the authors prefer a 7-day course of cephalexin 500 mg twice daily; when methicillin-resistant staphylococcal aureus (MRSA) is suspected based on presence of prurulent discharge, history of MRSA, or poor response to non-MRSA therapy, authors prefer doxycycline 100 mg twice per day for 7 days over trimethoprim-sulfamethoxazole due to lower incidence of hypersensitivity reactions with tetracyclines. Hospitalization and parenteral antibiotics may be necessary if a patient is severely ill, experiences rapid progression of erythema, or fails to respond to oral therapy. See Table 135-1.

Table 135-1Cellulitis and Erysipelas Treatment Table

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