eMedicine Specialties > Infectious Diseases > Skin and Soft-Tissue Infections
Cellulitis: Treatment & Medication
Updated: Sep 23, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Patients with cellulitis who have mild local symptoms and no evidence of systemic disease can be treated on an outpatient basis. Treatment duration for cellulitis is controversial; shorter-duration therapy may equally effective as longer-duration therapy.19
- In patients who respond slowly to therapy, antibiotics may need to be continued until inflammation resolves.
- The patient should be reassessed with short-interval follow-up, ideally within 48-72 hours, to ensure improvement.
- A transient increase in erythema over the first day of treatment is common and represents an inflammatory reaction to cell lysis caused by antibiotics.
- Development of systemic symptoms should prompt re-evaluation and consideration for admission.
- Apparent treatment failure at initial follow-up should prompt consideration for changing antimicrobial therapy and consulting with an infectious disease specialist.
- Patients with lymphangitic spread, systemic symptoms, rapidly evolving cellulitis, or need for surgical evaluation require admission for parenteral antibiotics.
- Concomitant hypotension and tachycardia indicate systemic disease and warrant intensive monitoring.
Surgical Care
- Urgent consultation with a surgeon should be sought in the setting of crepitus, circumferential cellulitis, necrotic-appearing skin, rapidly evolving cellulitis, pain disproportional to physical examination findings, severe pain on passive movement, or other clinical concern for necrotizing fasciitis.
- Serious concern for necrotizing fasciitis and/or the presence of necrotic skin should prompt examination of the fascial planes by direct observation. This can be performed at the bedside by an experienced surgeon in most cases.
- Circumferential cellulitis may result in compartment syndrome. Surgical decompression may be necessary. Measurement of compartment pressures may be helpful in diagnosis.
- Cellulitis associated with an abscess requires surgical drainage of the source of infection for adequate treatment.
Consultations
- Consider consultation with a surgeon, as described in Surgical Care.
- Consider consulting an infectious disease specialist if the patient is not improving with standard treatment or an unusual organism is identified.
- Consider consulting a critical care specialist for patients who are systemically ill and require admission to a critical care unit.
- Consider consulting an ophthalmologist in cases of orbital cellulitis.
Diet
No dietary restrictions exist in the management of cellulitis.
Activity
In general, no activity restrictions exist in the management of cellulitis, although elevation of the affected extremity may lessen the degree of edema and may improve the level of pain.
Medication
The goals of antimicrobial therapy are to eradicate the infection, to reduce morbidity, and to prevent complications.
- Beta-lactam agents have long been the mainstay of therapy for cellulitis. However, the recent increase in the prevalence of CA-MRSA in the general population,2 especially in cellulitis associated with abscess or purulent drainage, has changed this treatment paradigm to some degree. Common beta-lactam agents traditionally used to treat cellulitis do not cover CA-MRSA, and alternative agents are increasingly being used.
- In cases of cellulitis without draining wounds or abscess, streptococci continue to be the likely etiology,14 and beta-lactam antibiotics are appropriate therapy. In mild cases of cellulitis treated on an outpatient bases, dicloxacillin, amoxicillin, and cephalexin are all reasonable choices. Clindamycin or a macrolide (clarithromycin or azithromycin) are reasonable alternatives in patients who are allergic to penicillin. Patients who require parenteral therapy for severe cellulitis may be treated with cefazolin, cefuroxime, ceftriaxone, nafcillin, oxacillin, or clindamycin (in patients with a penicillin allergy).
- In many communities, CA-MRSA is the most common isolate from abscesses.20 Antibiotics used to treat cellulitis with abscess or purulent drainage should target CA-MRSA until proven otherwise with culture data.
- Mild cases that require only outpatient therapy may be treated with trimethoprim/sulfamethoxazole (TMP/SMX) and doxycycline. Available data suggest that doxycycline and TMP/SMX are equivalent in the treatment of mild skin and soft-tissue infections.21 It is important to note that TMP/SMX may not have adequate streptococcal coverage and should not be the first choice unless purulence is present.22
- Clindamycin may also be a reasonable choice depending on local sensitivities of CA-MRSA, but The Infectious Disease Society of America estimates that up to 50% of MRSA isolates have intrinsic or constitutive resistance to clindamycin in some regions.14
- In more severe cases that require parenteral antibiotics in areas where MRSA is thought to be a possible pathogen, vancomycin, daptomycin, tigecycline, and linezolid are appropriate choices. The newer agents have more limited data but have shown similar efficacy to vancomycin in some clinical trials.23 Daptomycin has been associated with more rapid resolution of signs and symptoms of cellulitis in some trials.24,25 However, vancomycin continues to be the drug of choice because of its overall excellent tolerability profile, efficacy, and cost.23
- Cellulitis associated with mammalian bite wounds is often polymicrobial and should be treated empirically with antimicrobials that target anaerobic bacteria in addition to the common cellulitis pathogens. CA-MRSA is not commonly associated with bite wounds. Mild cases can be treated on an outpatient basis with amoxicillin/clavulanate. In patients with penicillin allergy, combination therapy is usually required; fluoroquinolone plus clindamycin or TMP/SMX plus metronidazole would be reasonable alternatives. Inpatients can be treated with ampicillin/sulbactam or piperacillin/tazobactam. Alternatives in patients with penicillin allergy would be the same as the above but in parenteral form.
- Infections associated with diabetic ulcers are often polymicrobial. Empiric coverage in this setting should include broad coverage of gram-positive, gram-negative, and anaerobic organisms.9
In general, the clinician should choose empiric antimicrobial coverage for common pathogens in each given clinical scenario and narrow coverage if culture data become available. In patients who are not responding to therapy, consultation with an infectious disease specialist may be helpful.26 Knowledge of local organisms and resistance patterns plays an integral role in appropriate antimicrobial selection.
Antimicrobials
These agents are used to treat infections by killing bacteria or inhibiting bacterial growth. The goals of treatment are to eradicate the infection and to prevent sequelae. When selecting an antibiotic, choose the drug that provides appropriate empiric coverage. Antibiotics with the narrowest spectrum of activity are more appropriate than broad-spectrum agents.
Empiric oral therapy should cover GABHS and S aureus. If the infecting agent may be a water organism, treatment with parenteral piperacillin/tazobactam or doxycycline may be necessary.
Dicloxacillin (Dycill, Dynapen, Pathocil)
Binds to one or more penicillin-binding proteins, which in turn inhibits synthesis of bacterial cell walls. For treatment of infections caused by streptococci and penicillinase-producing staphylococci. May use to initiate therapy when staphylococcal or streptococcal infection is suspected. Resistance to this drug results from alterations in penicillin-binding proteins.
Adult
250-500 mg PO q6h
Pediatric
<2 months: Not established
<40 kg: 25 mg/kg/day PO divided q6h; not to exceed 2 g/day
>40 kg: Administer as in adults
Decreases efficacy of oral contraceptives; decreases effects of anticoagulants; probenecid and disulfiram may increase penicillin levels
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Note unpleasant taste of suspension; monitor PT in patients taking anticoagulant medications; toxicity may increase in patients with renal impairment
Nafcillin (Nafcil, Unipen, Nallpen)
Binds to penicillin-binding proteins, which in turn inhibits synthesis of bacterial cell walls. Resistance occurs by alterations in penicillin-binding proteins. Initial therapy for suspected streptococcal and penicillin-resistant staphylococcal infections.
Adult
2000 mg IV q4h
Pediatric
100 mg/kg/day IV divided q6h
Severe infections: May increase to 200 mg/kg/day divided q6h; not to exceed 6-12 g/day
Decreases efficacy of oral contraceptives and warfarin; disulfiram and probenecid may potentiate nafcillin
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Because of thrombophlebitis, particularly in elderly people, administer parenterally only for short term (1-2 d); change to oral route as clinically indicated; if switching to oral route in children, suggest using cephalexin because of greater palatability of suspension; monitor PT in patients taking anticoagulant medications; monitor for leukopenia; monitor liver function
Cephalexin (Keflex, Biocef, Keftab)
Binds to penicillin-binding proteins, which in turn inhibits synthesis of bacterial cell walls. Resistance occurs by alteration of penicillin-binding proteins. For treatment of infections caused by streptococci or penicillinase-producing staphylococci. May use to initiate therapy when streptococcal or staphylococcal infection is suspected. Because of drug's short half-life, q8h or q12h dosing is not optimal.
Adult
500 mg PO q6h; not to exceed 4 g/day
Pediatric
50 mg/kg/day PO divided q6h
Severe infections: 100 mg/kg/day PO divided q6h; not to exceed 3 g/day
Probenecid decreases clearance; coadministration with aminoglycosides increases nephrotoxic potential
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Coadministration with aminoglycosides increases nephrotoxic potential
Amoxicillin and clavulanate (Augmentin)
Amoxicillin inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. Addition of clavulanate inhibits beta-lactamase–producing bacteria. Resistance is caused by a change in penicillin-binding proteins.
Recommended for bites from cats, dogs, and humans.
Adult
500-875 mg PO bid
Pediatric
<40 kg: 25 mg/kg/day PO divided q12h
Severe infections: 45 mg/kg/day PO divided q12h
>40 kg: Administer as in adults
Decreases efficacy of oral contraceptives
Documented hypersensitivity; concomitant disulfiram use
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Potential cross sensitization with penicillin; adjust dosage for renal failure; do not use the 875-mg tablet in patients with PKU or renal failure
Cefazolin (Ancef, Kefzol, Zolicef)
First-generation semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth. Resistance occurs by alterations in penicillin-binding proteins. Primarily active against skin flora, including S aureus. Typically used alone for skin and skin-structure coverage.
Adult
1 g IV q8h
Severe infection: 2 g IV q6h
Pediatric
50-100 mg/kg/day IV divided q6-8h; not to exceed 6 g/day
Aminoglycosides increase potential nephrotoxicity; probenecid decreases clearance; may yield false-positive urine-dip test for glucose
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment; superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy
Piperacillin and tazobactam (Zosyn)
Semisynthetic penicillin with increased spectrum against gram-negative bacilli. Addition of tazobactam inhibits beta-lactamases produced by bacteria. Broad-spectrum drug for gram-positive, gram-negative, and anaerobic bacteria; covers most gram-positive organisms except MRSA
Adult
4.5 g IV q8h; alternatively, 3.375 g IV q6h; not to exceed 12 g/day
Pediatric
<12 years: Not established
>12 years: Administer as in adults
Decreases effect of oral contraceptives, increases effect of neuromuscular blocking agents if used with aminoglycosides; tetracyclines may decrease effects; synergistic effects when administered concurrently with aminoglycosides
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Use in children <12 y should be limited to pediatric subspecialists; check CBC counts prior to initiation of therapy and at least weekly during therapy; monitor for liver function abnormalities by measuring AST and ALT during therapy; caution in hepatic insufficiency; measure BUN and creatinine during therapy (adjust dose if values become elevated)
Ceftriaxone (Rocephin)
Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms. Bactericidal activity results from inhibiting cell wall synthesis by binding to one or more penicillin-binding proteins. Exerts antimicrobial effect by interfering with synthesis of peptidoglycan, a major structural component of bacterial cell wall. Bacteria eventually lyse owing to the ongoing activity of cell wall autolytic enzymes while cell wall assembly is arrested.
Highly stable in presence of beta-lactamases, both penicillinase and cephalosporinase, of gram-negative and gram-positive bacteria. Approximately 33%-67% of dose excreted unchanged in urine, and remainder secreted in bile and ultimately in feces as microbiologically inactive compounds. Reversibly binds to human plasma proteins, and binding has been reported to decrease from 95% bound at plasma concentrations <25 mcg/mL to 85% bound at 300 mcg/mL.
Adult
Severe infections: 1-2 g IV qday, or divided bid; not to exceed 4 g/day
Pediatric
Neonates >7 days: 25-50 mg/kg/day IV/IM; not to exceed 125 mg/day
Infants and children: 50-75 mg/kg/day IV/IM divided q12h; not to exceed 2 g/day
Coadministration with ethacrynic acid, furosemide, and aminoglycosides may increase nephrotoxicity
Documented hypersensitivity; hyperbilirubinemic neonates, particularly those who are premature
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections; caution in breastfeeding women; may displace bilirubin from albumin-binding sites, increasing the risk of kernicterus; caution with gallbladder, biliary tract, liver, or pancreatic disease or in patients with history of colitis or penicillin hypersensitivity
Ampicillin and sulbactam (Unasyn)
Drug combination of beta-lactamase inhibitor with ampicillin. Interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. Alternative to amoxicillin/clavulanate when unable to take medication orally. Covers skin, enteric flora, and anaerobes. Ideal for mammalian bite wounds. Not ideal for nosocomial pathogens.
Adult
1.5 (1 g ampicillin + 0.5 g sulbactam) to 3 g (2 g ampicillin + 1 g sulbactam) IV/IM q 6-8h; not to exceed 4 g/day sulbactam or 8 g/day ampicillin
Pediatric
<3 months: Not established
3 months to 12 years: 100-200 mg ampicillin/kg/day (150-300 mg Unasyn) IV divided q6h
>12-years: Administer as in adults; not to exceed 4 g/day sulbactam or 8 g/day ampicillin
Allopurinol decreases ampicillin effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal failure; evaluate rash and differentiate from hypersensitivity reaction
Doxycycline (Bio-Tab, Doryx, Vibramycin, Doxy, Vibra-Tabs)
Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. Provides good coverage against spirochetes, many gram-negative organisms, anaerobic organisms, atypical bacteria, and many gram-positive organisms, including most CA-MRSA.
Adult
100 mg PO q12h
Pediatric
<8 years: Not recommended
>8 years: 5 mg/kg/day IV divided q12h; not to exceed 200 mg/day
Minimally decreases levels if taken orally with aluminum, calcium, or magnesium; increases effect of warfarin; barbiturates, phenytoin, and carbamazepine decrease half-life of doxycycline; tetracyclines can decrease effect of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy
Documented hypersensitivity; hepatic dysfunction; pregnancy
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Relative contraindication for patients <8 years (use in children <8 y should be limited to pediatric subspecialists); rarely photosensitivity may occur; use during tooth development (ie, last half of pregnancy, children to age 8 y) can cause permanent discoloration of teeth; risk of erosive esophagitis
Clindamycin (Cleocin)
Lincosamide for treatment of serious skin and soft-tissue staphylococcal infections, including some CA-MRSA. Also effective against aerobic and anaerobic streptococci (except enterococci). Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Adult
150-300 mg/dose PO q6-8h; not to exceed 1.8 g/day; alternatively, 600 mg IV divided q8h, depending on degree of infection; not to exceed 4.8 g/day
Pediatric
8-20 mg/kg/day PO as hydrochloride and 8-25 mg/kg/day as palmitate divided tid/qid; not to exceed 1.8 g/day
20-40 mg/kg/day IV/IM divided tid/qid; not to exceed 4.8 g/day
Increases duration of neuromuscular blockade induced by tubocurarine and pancuronium; erythromycin may antagonize effects of clindamycin; antidiarrheals may delay absorption of clindamycin
Documented hypersensitivity; regional enteritis; ulcerative colitis; hepatic impairment; antibiotic-associated colitis
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal Clostridium difficile infection
Linezolid (Zyvox)
Prevents formation of functional 70S initiation complex, which is essential for bacterial translation process. Bacteriostatic against enterococci and staphylococci, including MRSA and CA-MRSA. Bactericidal against most strains of streptococci.
Adult
600 mg PO/IV q12h
Pediatric
Not established
May cause hypertension when used concomitantly with adrenergic agents, including pseudoepinephrine, sympathomimetic agents, vasopressor, or dopaminergic agents (reduce dose of dopamine or epinephrine if concurrent use required); serotonin syndrome may occur if used concomitantly with serotonergic agents, including tricyclic antidepressants, meperidine, dextromethorphan, trazodone, venlafaxine, and selective serotonin reuptake inhibitors
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Has mild MAOI properties and has potential to have same interactions as other MAOIs; caution in uncontrolled hypertension, pheochromocytoma, carcinoid syndrome, or untreated hyperthyroidism, and patients who are at increased risk for bleeding, have preexisting thrombocytopenia, receive concomitant medications that may decrease platelet count or function, or who may require >2 wk of therapy (monitor platelet counts); monitor for peripheral neuropathy with prolonged use
Daptomycin (Cubicin)
Binds to bacterial membranes and causes rapid membrane potential depolarization, thereby inhibiting protein, DNA, and RNA synthesis, ultimately causing cell death. Indicated to treat complicated skin and skin structure infections caused by S aureus (including methicillin-resistant strains), S pyogenes, S agalactiae, S dysgalactiae, and E faecalis (vancomycin-susceptible strains only).
Adult
CrCl >30 mL/min: 4 mg/kg IV q24h infused over 30 min
CrCl <30 mL/min: 4 mg/kg IV q48h (including hemodialysis or CAPD)
Pediatric
No data for patients <18 years
Coadministration with tobramycin slightly increase daptomycin Cmax and AUC and decreases tobramycin Cmax and AUC; may experience additive effects with other drugs that cause myopathy (eg, HMG CoA reductase inhibitors)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Decrease dose with renal function <30 mL/min; pseudomembranous colitis may occur; may cause muscle pain or weakness; monitor CPK levels and discontinue daptomycin with elevated CPK and unexplained myopathy or marked CPK elevation (10 times upper limits of normal); not indicated for pneumonia (higher death rate in daptomycin-treated patients during phase III trials); not compatible with dextrose-containing solutions
Tigecycline (Tygacil)
A glycylcycline antibiotic that is structurally similar to tetracycline antibiotics. Inhibits bacterial protein translation by binding to 30S ribosomal subunit and blocks entry of amino-acyl tRNA molecules in ribosome A site. Indicated for complicated skin and skin structure infections caused by E coli, E faecalis (vancomycin-susceptible isolates only), S aureus (methicillin-susceptible and -resistant isolates), S agalactiae, S anginosus group (includes S anginosus, S intermedius, and S constellatus), S pyogenes, and B fragilis.
Adult
Infuse each dose over 30-60 min
100 mg IV once, then 50 mg IV q12h
Severe hepatic impairment (ie, Child Pugh class C): 100 mg IV once, then 25 mg IV q12h
Pediatric
<18 years: Not established
>18 years: Administer as in adults
Coadministration decreases warfarin clearance and increases warfarin Cmax and AUC (monitor aPTT and INR); coadministration with oral contraceptives may decrease contraceptive effect
Documented hypersensitivity
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in severe hepatic impairment (reduce dose); may adversely effect tooth development; may permit clostridia overgrowth, resulting in antibiotic-associated colitis; may have adverse effects similar to tetracyclines (eg, photosensitivity, pseudotumor cerebri, pancreatitis, antianabolic action); nausea is common
Vancomycin (Vancocin)
Indicated for patients who cannot receive or have failed to respond to penicillins and cephalosporins or have infections with resistant staphylococci, including CA-MRSA and MRSA.
To avoid toxicity, current recommendation is to assay vancomycin trough levels after fourth dose drawn 0.5 h prior to next dosing. Use CrCl to adjust dose in patients diagnosed with renal impairment.
Adult
15 mg/kg IV q12h
Pediatric
40mg/kg/day IV divided q6-8h
Erythema, histaminelike flushing and anaphylactic reactions may occur when administered with anesthetic agents; taken concurrently with aminoglycosides, risk of nephrotoxicity may increase above that with aminoglycoside monotherapy; effects in neuromuscular blockade may be enhanced when coadministered with nondepolarizing muscle relaxants
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in renal failure, neutropenia; red man syndrome is caused by too-rapid IV infusion (dose given over a few minutes) but rarely happens when dose given IV over 2 h administration or as PO or IP administration; red man syndrome is not an allergic reaction
Telavancin (Vibativ)
Lipoglycopeptide antibiotic that is a synthetic derivative of vancomycin. Inhibits bacterial cell wall synthesis by interfering with polymerization and cross-linking of peptidoglycan. Unlike vancomycin, telavancin also depolarizes the bacterial cell membrane and disrupts its functional integrity. Indicated for complicated skin and skin structure infections caused by susceptible gram-positive bacteria, including Staphylococcus aureus (both methicillin-resistant and methicillin-susceptible strains), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus anginosus group, and Enterococcus faecalis (vancomycin-susceptible isolates only).
Adult
10 mg/kg IV q24h for 7-14 d; infuse over 1 h
CrCl 30-50 mL/min: 7.5 mg/kg/d
CrCl 10-29 mL/min: 10 mg/kg q48h
Pediatric
Not established
Data limited; coadministration with other drugs that prolong QTc interval (eg, phenothiazine, TCAs, macrolide antibiotics, class I and III antiarrhythmic agents) may increase risk for life-threatening arrhythmias
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Common adverse effects include taste disturbance, nausea, vomiting, and foamy urine; new-onset or worsening renal impairment has been reported (monitor renal function); efficacy decreased with moderate-to-severe baseline renal impairment (ie, CrCl <50 mL/min); administer over at least 1 h to minimize infusion-related adverse reactions; Clostridium difficile –associated diarrhea may occur; may prolong QTc interval; interferes with coagulation test results, including PT, INR, and aPTT, but does not interfere with coagulation
Moxifloxacin (Avelox)
Inhibits the A subunits of DNA gyrase, resulting in inhibition of bacterial DNA replication and transcription.
Adult
400 mg PO/IV qday
Pediatric
<18 years: Not recommended
>18 years: Administer as in adults
Antacids reduce absorption; loop diuretics, probenecid, and cimetidine increase serum levels; NSAIDs enhance CNS-stimulating effect; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT); ferrous sulfate decreases bioavailability (administer moxifloxacin 4 h prior or 8 h following cations, eg, Fe, Mg, Zinc, Ca); coadministration with drugs that prolong QTc interval (quinidine, procainamide, amiodarone, sotalol, erythromycin, tricyclic antidepressants) increase risk of life-threatening arrhythmia
Documented hypersensitivity; known QT prolongation; concurrent administration of drugs that cause QT prolongation
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); superinfections may occur with prolonged or repeated antibiotic therapy; fluoroquinolones have induced seizures in CNS disorders and caused tendinitis or tendon rupture, especially in elderly patients and with concurrent steroid use
More on Cellulitis |
| Overview: Cellulitis |
| Differential Diagnoses & Workup: Cellulitis |
 Treatment & Medication: Cellulitis |
| Follow-up: Cellulitis |
| Multimedia: Cellulitis |
| References |
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Further Reading
Keywords
cellulitis, gram-positive bacteria, group A beta-hemolytic Streptococcus, GABHS, Staphylococcus aureus, S aureus, MRSA, methicillin-resistant Staphylococcus aureus, CA-MRSA, community-acquired MRSA, Streptococcus pyogenes, S pyogenes, systemic toxins, bacteremia, sepsis, buccal cellulitis, Haemophilus influenzae type B, HIB, facial cellulitis, perianal cellulitis, group B Streptococcus cellulitis, Pseudomonas osteomyelitis, septic arthritis, thrombophlebitis, Pasteurella multocida, P multocida, Vibrio vulnificus, V vulnificus, Aeromonas species, Clostridium perfringens, C perfringens, crepitus, crepitation, Escherichia coli cellulitis, E coli, septic shock
