TREATMENT OF CELLULITIS
Cellulitis should be treated with systemic antibiotics. Limited disease of the torso and extremities can be treated with oral antibiotics. Treatment choices include penicillinase-resistant penicillins, first-generation cephalosprins, amoxicillin-clavulonate, broad-spectrum macrolides, second-
generation fluoroquinolones, or clindamycin. Some clinicians administer an initial dose of intravenous antibiotics (i.e., cefazolin, ceftriaxone) to reduce the risk of progression before starting oral medication.
A recent study demonstrated the effectiveness of home-administered once-daily intravenous cefazolin plus oral probenecid. Close follow-up is important once treatment is started. At the initial visit, the margin of the rash should be traced with a marker. Patients should be seen within 24 hours for reassessment. Most cases will improve after 1 day of treatment, but sometimes it may take several days to see regression. As long as the cellulitis does not progress, it is reasonable to continue the initial antibiotic and monitor patients closely. Once the infection has demonstrated significant regression, patients can be instructed to finish their antibiotics and return as needed.
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