Cellulitis and Soft Tissue Infections Pamela Orr Professor, Internal Medicine, Medical Microbiology and Community Health Sciences

Investigation Blood cultures if fever history/objective fever/chills/systemic symptoms or signs/immunosuppressed Blood cultures if fever history/objective fever/chills/systemic symptoms or signs/immunosuppressed Check for Tinea pedis if lower extremity involved Check for Tinea pedis if lower extremity involved Culture any open wounds (including anaerobic culture if deep or necrotic or malodorous) Culture any open wounds (including anaerobic culture if deep or necrotic or malodorous) CBC, urea, creatinine, glucose CBC, urea, creatinine, glucose Image – eg. CT of orbit and brain Image – eg. CT of orbit and brain Incise and drain and pack !! Incise and drain and pack !!

Treatment Cellulitis not associated with wound – usually Streptococcus A (B/C/G) / MSSA/ MRSA (or Strep Pneumoniae or Haemophilus influenzae in orbital cellulitis) Cellulitis not associated with wound – usually Streptococcus A (B/C/G) / MSSA/ MRSA (or Strep Pneumoniae or Haemophilus influenzae in orbital cellulitis) iv Ceftriaxone 2 gm/day +/- iv Vancomycin iv Ceftriaxone 2 gm/day +/- iv Vancomycin Pen allergy: iv Clindamycin or Vancomycin Pen allergy: iv Clindamycin or Vancomycin Oral: Cloxacillin or Cephalexin (or Clinda if Pen allergic) - add Septra or Doxycycline if MRSA is suspected Oral: Cloxacillin or Cephalexin (or Clinda if Pen allergic) - add Septra or Doxycycline if MRSA is suspected Cefuroxime-axetil in orbital cellulitis Cefuroxime-axetil in orbital cellulitis Eryripelas – Strep A Eryripelas – 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 allergic) Oral: Penicillin V or Amoxil (or Clinda if Pen allergic)

Treatment Diabetic Foot Infection – usually mixed gram +/- /anaerobes. Decide whether osteomyelitis is present, and assess arterial pulses. Often needs iv therapy. Start with (after cultures): eg. iv Ceftriaxone +iv Vanco+ po Metronidazole eg. iv Ceftriaxone +iv Vanco+ po Metronidazole eg. po Amoxicillin/Clavulinic Acid +/- Doxy, or po Septra + Metro eg. po Amoxicillin/Clavulinic Acid +/- Doxy, or po Septra + Metro Wound Infection – likley mixed infection, as above. Same approach. If Water exposure think of Pseudomonas – use Ceftazidime or Ciprofloxacin instead of Ceftriaxone Head and Neck Region Infections : Be very cautious