Cellulitis and Cellulitis and Soft Tissue Soft Tissue InfectionsInfections

Pamela OrrPamela OrrProfessor, Internal Medicine, Professor, Internal Medicine,

Medical Microbiology and Medical Microbiology and Community Health SciencesCommunity Health Sciences

InvestigationInvestigation

Blood cultures if fever history/objective Blood cultures if fever history/objective fever/chills/systemic symptoms or fever/chills/systemic symptoms or signs/immunosuppressedsigns/immunosuppressed

Check for Tinea pedis if lower extremity Check for Tinea pedis if lower extremity involvedinvolved

Culture any open wounds (including anaerobic Culture any open wounds (including anaerobic culture if deep or necrotic or malodorous)culture if deep or necrotic or malodorous)

CBC, urea, creatinine, glucoseCBC, urea, creatinine, glucose Image – eg. CT of orbit and brainImage – eg. CT of orbit and brain Incise and drain and pack !!Incise and drain and pack !!

TreatmentTreatment Cellulitis not associated with wound – Cellulitis not associated with wound –

usually Streptococcus A (B/C/G) / MSSA/ usually Streptococcus A (B/C/G) / MSSA/ MRSA (or Strep Pneumoniae or MRSA (or Strep Pneumoniae or Haemophilus influenzae in orbital cellulitis)Haemophilus influenzae in orbital cellulitis) iv Ceftriaxone 2 gm/day +/- iv Vancomyciniv Ceftriaxone 2 gm/day +/- iv Vancomycin Pen allergy: iv Clindamycin or VancomycinPen allergy: iv Clindamycin or Vancomycin Oral: Cloxacillin or Cephalexin (or Clinda if Pen Oral: Cloxacillin or Cephalexin (or Clinda if Pen

allergic) - add Septra or Doxycycline if MRSA is allergic) - add Septra or Doxycycline if MRSA is suspected suspected

Cefuroxime-axetil in orbital cellulitisCefuroxime-axetil in orbital cellulitis Eryripelas – Strep AEryripelas – Strep A

iv Ceftriaxone (or Pen or Ampicillin)iv Ceftriaxone (or Pen or Ampicillin) Pen Allergy: iv Clindamycin (or Vanco)Pen Allergy: iv Clindamycin (or Vanco) Oral: Penicillin V or Amoxil (or Clinda if Pen Oral: Penicillin V or Amoxil (or Clinda if Pen

allergic)allergic)

TreatmentTreatment

Diabetic Foot InfectionDiabetic Foot Infection – usually mixed gram – usually mixed gram +/-/anaerobes. Decide whether osteomyelitis is present, and +/-/anaerobes. Decide whether osteomyelitis is present, and assess arterial pulses. Often needs iv therapy. Start with assess arterial pulses. Often needs iv therapy. Start with (after cultures):(after cultures): eg. iv Ceftriaxone +iv Vanco+ po Metronidazoleeg. iv Ceftriaxone +iv Vanco+ po Metronidazole eg. po Amoxicillin/Clavulinic Acid +/- Doxy, or po Septra eg. po Amoxicillin/Clavulinic Acid +/- Doxy, or po Septra

+ Metro+ Metro

Wound InfectionWound Infection – likley mixed infection, as above. – likley mixed infection, as above. Same approach. If Water exposure think of Pseudomonas Same approach. If Water exposure think of Pseudomonas – use Ceftazidime or Ciprofloxacin instead of Ceftriaxone – use Ceftazidime or Ciprofloxacin instead of Ceftriaxone

Head and Neck Region InfectionsHead and Neck Region Infections: Be very cautious : Be very cautious