• Cellulitis SSOU Guideline

    Definition

     Acute onset of superfi cial skin infection in an otherwise well, ambulant patient. 

    Note that abscesses need incision and drainage as well as antibiotic treatment. 

    Admission Criteria

    • Clinical diagnosis of cellulitis
    • Awaiting HITH transfer in < 24hrs
    • Failed min 24 hrs oral therapy (relative)
    • DVT unlikely clinically

     

    Exclusion Criteria

    • Major co-morbidities ie diabetes, peripheral vasc dis / DVT
    • Bilateral cellulitis (liposclerosis more likely)
    • Severe cellulitis involving orbital area, facial, perineal region
    • Extensive tissue damage or sloughing
    • Obvious subcutaneous collection requiring surgical drainage
    • Chronic lymphoedema

     

    Investigations

    • FBE
    • UEC
    • Glucose 
    • Consider ultrasound if in doubt about DVT or collection

     

    Suggested Medications

     
    Drug Dose  Frequency  Route 
    Cephalexin (preferred if referring to HITH) 2g12/24IV
    Diclox / Flucloxacillin1-2g6 hourlyoral / IV
    Paracetamol 1g 4-6/24oral 
        
       
        

     

    Specific Observations

    • Report any increasing redness, pain or swelling
    • Report evidence of systemic infection / sepsis

     

    Specific Management Issues

    • HITH notification early if HITH is intended discharge destination
    • General Medicine (AMU) registrar if HITH admission required. 
    • Surgical consult if collection suspected that cannot be drained in ED (most skin abscesses can be drained in ED, as the ED reg or consultant first)

     

    Discharge Criteria

    • Afebrile (T <38 C)
    • Follow – up arranged
    • HITH arranged
    • Independent in ADL

     

    Hospital Admission Criteria

    • Persisting systemic illness
    • Progressing cellulitis
    • Unclear diagnosis
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