Key Information Summary
Cellulitis is an acute spreading bacterial infection of the deep dermis and subcutaneous tissue, characterised by erythema, warmth, swelling, and pain. It is one of the most common skin and soft tissue infections (SSTIs) encountered in clinical practice, with significant morbidity if inadequately treated.
Definition and Classification
Cellulitis involves infection of the deeper skin layers and subcutaneous tissue, distinguished from:
- Erysipelas: superficial dermis infection with raised, well-demarcated borders
- Impetigo: superficial skin infection
- Necrotising fasciitis: deep tissue infection involving fascia and muscle
Epidemiology
- Affects all age groups, with increasing incidence in elderly and immunocompromised patients
- Annual incidence: approximately 200-250 per 100,000 population in Australia
- Responsible for 2-3% of emergency department presentations
- Higher rates in Aboriginal and Torres Strait Islander populations, particularly in remote communities
- Significant healthcare burden with frequent hospitalisation requirements
Microbiology
Primary pathogens:
- Streptococcus pyogenes (Group A Streptococcus) - most common cause
- Staphylococcus aureus (including MRSA) - increasing prevalence
- Group C and G beta-haemolytic streptococci
Special circumstances:
- Diabetic foot infections: polymicrobial including anaerobes, Pseudomonas aeruginosa
- Immunocompromised hosts: broader spectrum including Gram-negative bacteria
- Water exposure: Aeromonas hydrophila, Vibrio species
- Animal bites: Pasteurella multocida, Capnocytophaga canimorsus
Risk Factors
Patient factors:
- Diabetes mellitus
- Chronic venous insufficiency
- Lymphoedema
- Obesity
- Immunocompromised states
- Peripheral vascular disease
- Previous cellulitis episodes
- Chronic kidney disease
Skin barrier disruption:
- Trauma, wounds, surgical sites
- Tinea pedis (athlete's foot)
- Eczema or dermatitis
- Injection drug use
- Insect bites
- Ulceration
Clinical Severity Classification
Mild (outpatient management):
- Localised infection without systemic signs
- Immunocompetent patient
- Able to take oral medications
Moderate (consider hospitalisation):
- Extensive local infection
- Mild systemic symptoms
- Comorbidities present
- Failed outpatient therapy
Severe (hospitalisation required):
- Systemic toxicity (fever >38ยฐC, tachycardia, hypotension)
- Rapidly spreading infection
- Immunocompromised host
- Suspicion of deeper infection or necrotising fasciitis
- Unable to tolerate oral therapy
Complications
- Bacteraemia and sepsis
- Necrotising fasciitis
- Abscess formation
- Chronic lymphoedema
- Post-infectious glomerulonephritis (with streptococcal infection)
- Recurrent cellulitis
Aboriginal and Torres Strait Islander Considerations
- Higher prevalence of predisposing conditions (diabetes, renal disease)
- Environmental factors in remote communities (crowded housing, limited access to clean water)
- Cultural considerations for treatment compliance
- Need for community-based care models
- Higher rates of Group A Streptococcal disease and complications including post-infectious glomerulonephritis and acute rheumatic fever
Antimicrobial Resistance Patterns in Australia
- MRSA prevalence: approximately 15-25% of S. aureus isolates
- Vancomycin-resistant enterococci (VRE) emerging concern
- Extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae in diabetic foot infections
- Clindamycin resistance in Group A Streptococcus: 5-10% nationally
Key Clinical Pearls
- Cellulitis diagnosis is primarily clinical - blood cultures rarely positive in uncomplicated cases
- Consider necrotising fasciitis if pain disproportionate to clinical findings
- Bilateral lower limb "cellulitis" is rarely infectious - consider venous insufficiency, heart failure
- Recurrent cellulitis warrants investigation for predisposing factors
- Early appropriate antibiotic therapy significantly reduces complications and length of stay
Introduction
Cellulitis is a common acute bacterial infection of the deep dermis and subcutaneous tissue, characterised by spreading erythema, warmth, swelling, and tenderness. It represents one of the most frequent skin and soft tissue infections (SSTIs) encountered in Australian clinical practice, accounting for significant morbidity and healthcare utilisation across emergency departments, general practice, and hospital admissions.
The infection typically occurs when bacteria breach the skin barrier through minor trauma, insect bites, surgical wounds, or pre-existing skin conditions such as eczema, tinea pedis, or chronic venous insufficiency. The pathophysiology involves bacterial invasion of the deeper skin layers with subsequent inflammatory response and potential systemic spread if inadequately treated.
Epidemiology and Risk Factors
Cellulitis affects all age groups but demonstrates increased incidence in older adults, with peak prevalence in patients over 65 years. In Australia, cellulitis accounts for approximately 2-3% of emergency department presentations and represents a leading cause of hospital admission for infectious conditions.
The condition shows seasonal variation, with higher rates during warmer months coinciding with increased outdoor activities and insect exposure.
Key predisposing factors include:
- Compromised skin integrity (chronic wounds, dermatitis, tinea pedis)
- Lymphatic dysfunction or lymphoedema
- Venous insufficiency and chronic leg ulceration
- Diabetes mellitus and peripheral vascular disease
- Immunocompromised states
- Previous episodes of cellulitis
- Obesity and immobility
- Injection drug use
Microbiology
The predominant causative organisms in Australia reflect international patterns, with beta-haemolytic streptococci (particularly Streptococcus pyogenes and Streptococcus agalactiae) and Staphylococcus aureus representing the most common pathogens. Methicillin-resistant Staphylococcus aureus (MRSA) prevalence varies by geographic region and healthcare setting, with community-associated MRSA (CA-MRSA) comprising approximately 15-25% of S. aureus isolates in many Australian centres.
Less common but clinically significant pathogens include:
- Gram-negative organisms in immunocompromised hosts or those with specific exposures
- Pasteurella species following animal bites
- Vibrio vulnificus in saltwater exposure contexts
- Aeromonas species in freshwater exposure
Clinical Significance
Cellulitis represents a spectrum of disease severity, ranging from localised superficial infection to life-threatening necrotising fasciitis. Early recognition and appropriate management are crucial to prevent complications including bacteraemia, abscess formation, necrotising infection, and chronic lymphatic dysfunction.
The condition significantly impacts quality of life and healthcare resources, with recurrence rates of 15-30% within two years of initial episode.
Australian Healthcare Context
Management of cellulitis in Australia must consider several unique factors:
- Geographic isolation affecting specialist referral patterns in rural and remote areas
- Higher prevalence of diabetes and cardiovascular disease in certain populations
- Specific considerations for Aboriginal and Torres Strait Islander peoples, including increased rates of diabetes, renal disease, and skin infections
- Seasonal variations in presentation patterns
- Antimicrobial resistance patterns specific to Australian healthcare settings
- Integration with existing chronic disease management programs for high-risk populations
The condition's management aligns with National Safety and Quality Health Service (NSQHS) Standards, particularly regarding antimicrobial stewardship, clinical governance, and partnering with consumers in care decisions.
Microbiology
Common Causative Organisms
Beta-haemolytic Streptococci
Group A Strep
Streptococcus pyogenes
Most common cause of non-purulent cellulitis
- Rapid spreading infection with distinct margins
- Associated with lymphangitis and systemic toxicity
- Risk factors: diabetes, immunocompromise, chronic venous insufficiency
- Produces multiple virulence factors including streptolysin O and S
Group B Strep
Streptococcus agalactiae
- Common in elderly patients and those with diabetes
- Often affects lower limbs
- Associated with recurrent episodes
- May cause bacteraemia
Group C/G Strep
Streptococcus dysgalactiae subspecies equisimilis
- Increasing recognition as significant pathogen
- Similar clinical presentation to S. pyogenes
- Often affects patients with underlying conditions
Staphylococcus aureus
MSSA
Methicillin-susceptible S. aureus
- Common in purulent cellulitis and abscesses
- Associated with trauma, surgical sites, and foreign bodies
- Produces multiple toxins including Panton-Valentine leukocidin (PVL)
MRSA
Methicillin-resistant S. aureus
- Community-associated MRSA (CA-MRSA) increasingly prevalent
- Often PVL-positive causing necrotising infections
- Healthcare-associated MRSA (HA-MRSA) in hospitalised patients
- Current Australian prevalence: 15-25% of S. aureus isolates
Emerging and Resistant Pathogens
Enterobacteriaceae
Escherichia coli
- Diabetic foot infections
- Post-surgical wound infections
- Often multi-drug resistant
Klebsiella pneumoniae
- Associated with immunocompromised patients
- Increasing carbapenem resistance (CPE)
Non-fermenting Gram-negative Bacilli
Pseudomonas aeruginosa
- Diabetic foot infections
- Burn wounds
- Immunocompromised patients
- Intrinsic resistance to multiple antibiotics
Special Populations and Pathogens
Higher prevalence of:
- Group A Streptococcal infections
- Staphylococcal infections including CA-MRSA
- Post-infectious glomerulonephritis risk
- Rheumatic fever susceptibility
Water-related Exposures
Aeromonas species
Freshwater exposure, immunocompromised patients, often polymicrobial infections
Vibrio vulnificus
Marine water exposure, rapidly progressive necrotising infection, high mortality in immunocompromised
Animal Bites and Scratches
Pasteurella multocida
Cat and dog bites, rapid onset (< 24 hours), often polymicrobial
Capnocytophaga canimorsus
Dog bites, severe infection in asplenic patients
Immunocompromised Patients
Atypical organisms:
- Non-tuberculous mycobacteria
- Cryptococcus neoformans
- Nocardia species
- Aspergillus and other moulds
Australian Antimicrobial Resistance Patterns
Current Resistance Trends (2023 Data)
- S. aureus MRSA prevalence: 15-25% nationally
- Enterobacteriaceae ESBL: 15-20% E. coli, 25-30% K. pneumoniae
- Carbapenem-resistant Enterobacteriaceae (CRE): <1% but increasing
- Vancomycin-resistant Enterococci (VRE): 15-20% E. faecium
Regional Variations
Northern Australia
Higher rates of tropical pathogens
Remote Communities
Limited laboratory facilities affecting pathogen identification
Urban Centres
Higher prevalence of healthcare-associated resistant organisms
Polymicrobial Infections
Common Combinations
- Streptococci + Staphylococci in chronic wounds
- Aerobic + anaerobic bacteria in diabetic foot infections
- Gram-positive + Gram-negative in post-surgical infections
Risk Factors for Polymicrobial Infection
- Diabetic foot ulcers
- Chronic venous insufficiency
- Immunocompromise
- Previous antibiotic exposure
- Hospital-acquired infections
Laboratory Considerations
Specimen Collection
Essential
Blood cultures
Essential in severe cellulitis or systemic signs
Available
Wound swabs
Limited value in non-purulent cellulitis
Specialist
Tissue biopsy
Gold standard but rarely performed
Specialist
Needle aspiration
May be considered in severe cases
Molecular Diagnostics
- PCR for resistant genes (mecA, vanA/B)
- Rapid pathogen identification systems
- PVL detection in suspected necrotising infections
Biomarkers
- Procalcitonin for bacterial vs viral differentiation
- C-reactive protein for monitoring treatment response
- Lactate in suspected necrotising fasciitis
Clinical Presentation
Typical Features
Cellulitis presents as an acute spreading infection of the skin and subcutaneous tissues characterised by:
- Erythema: Red, warm, tender skin that spreads rapidly
- Swelling: Localised oedema extending beyond the area of erythema
- Pain: Usually moderate to severe, often described as throbbing or burning
- Warmth: Increased skin temperature over affected area
- Induration: Firm, woody texture to affected tissue
- Poorly demarcated borders: Unlike erysipelas, margins are typically ill-defined
- Lymphangitis: Red streaking may be visible tracking towards regional lymph nodes
- Lymphadenopathy: Regional lymph nodes often enlarged and tender
Anatomical Distribution
Lower Limb Cellulitis
- Most common site (60-70% of cases)
- Often bilateral in patients with chronic venous insufficiency or lymphoedema
- May involve entire leg from foot to groin in severe cases
- Associated with tinea pedis, venous ulceration, or minor trauma
Upper Limb Cellulitis
- Less common than lower limb involvement
- Often related to IV drug use, trauma, or surgical sites
- May involve hand, forearm, or entire arm
- Consider necrotising fasciitis if severe pain disproportionate to clinical findings
Facial Cellulitis
Requires urgent assessment due to risk of orbital or intracranial extension
- May be associated with dental infections, sinusitis, or insect bites
- Periorbital involvement necessitates ophthalmological assessment
Truncal Cellulitis
- Less common, often post-surgical or post-traumatic
- Consider underlying immunocompromise if recurrent
Systemic Features
Mild to Moderate Cellulitis
- Low-grade fever (37.5-38.5ยฐC) or absent
- Minimal systemic upset
- Able to maintain oral intake
- Normal or mildly elevated inflammatory markers
Severe Cellulitis
- High fever (>38.5ยฐC) with rigors
- Malaise, lethargy, confusion (especially elderly)
- Nausea, vomiting, reduced oral intake
- Tachycardia, hypotension
- Significantly elevated inflammatory markers (CRP >100 mg/L, WCC >15 ร 10โน/L)
High-Risk Presentations
Necrotising Fasciitis Indicators
- Pain disproportionate to clinical findings
- Rapid progression over hours
- Bullae or skin necrosis
- Systemic toxicity with high fever and altered mental state
- Crepitus (gas-forming organisms)
- Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score โฅ6
Orbital Cellulitis Features
- Proptosis, diplopia, or reduced visual acuity
- Pain on eye movement
- Restricted extraocular movements
- Reduced visual fields or afferent pupillary defect
Special Population Considerations
Aboriginal and Torres Strait Islander Patients
- Higher rates of Group A Streptococcal (GAS) cellulitis
- More likely to develop complications including bacteraemia
- Consider underlying conditions: diabetes, chronic kidney disease, rheumatic heart disease
- Higher prevalence of MRSA colonisation in some communities
- May present later due to healthcare access barriers
Elderly Patients
- Often present with minimal local signs but significant systemic upset
- Confusion may be the predominant feature
- Higher risk of complications and hospitalisation
- Consider underlying conditions: diabetes, peripheral vascular disease, immunosuppression
Immunocompromised Patients
- May have atypical presentations with minimal inflammatory response
- Higher risk of unusual organisms (fungi, atypical bacteria)
- Rapid progression more likely
- Consider drug-resistant organisms
Diabetic Patients
- Often more extensive involvement
- May have minimal pain due to neuropathy
- Higher risk of deep tissue involvement and osteomyelitis
- Consider diabetic foot infection classification if foot involvement
Differential Diagnosis Considerations
Features Suggesting Alternative Diagnoses
Deep Vein Thrombosis
- Unilateral leg swelling with prominent venous pattern
- Less erythema, more bluish discolouration
- Homan's sign may be positive
Lipodermatosclerosis
- Chronic bilateral lower leg changes
- 'Inverted champagne bottle' appearance
- Associated with chronic venous insufficiency
Contact Dermatitis
- Clear history of exposure to allergen or irritant
- Well-demarcated borders matching exposure pattern
- Vesicles or bullae may be present
Erysipelas
- Raised, well-demarcated borders
- More superficial than cellulitis
- Classic 'butterfly' distribution on face
Severity Assessment
Eron Classification
Class I (Mild)
- No signs of systemic toxicity
- No uncontrolled comorbidities
- Suitable for outpatient oral therapy
Class II (Moderate)
- Systemically ill or systemically well with comorbidities
- May require hospitalisation for IV therapy
Class III (Severe)
- Significant systemic toxicity
- Limb-threatening infection
- Requires hospitalisation and IV therapy
Class IV (Life-threatening)
- Sepsis syndrome or life-threatening infection
- Requires urgent hospitalisation and aggressive therapy
Documentation Requirements
Essential clinical documentation should include:
- Site, size, and extent of erythema (measure and mark borders)
- Presence or absence of systemic features
- Severity assessment and classification
- Risk factors and comorbidities
- Response to previous treatments
- Functional impact (mobility, work capacity)
- Photography may be useful for monitoring progression
Investigations
Clinical Assessment
Cellulitis is primarily a clinical diagnosis based on history and physical examination. Laboratory investigations are generally not required for typical cases presenting with classic features of erythema, warmth, swelling, and tenderness in an otherwise well patient.
Blood Tests
Full Blood Count
Essential
Full Blood Count
Indicated for:
- Severe cellulitis
- Systemically unwell patients (fever, rigors, hypotension)
- Suspected necrotising fasciitis
- Immunocompromised patients
- Diabetic patients with severe infection
Leucocytosis may be present but is not diagnostic. Normal white cell count does not exclude cellulitis.
Inflammatory Markers
Available
C-Reactive Protein (CRP)
- Useful for monitoring treatment response in severe cases
- Elevated CRP supports diagnosis in uncertain cases
- Serial CRP measurements helpful for assessing treatment efficacy
Available
Erythrocyte Sedimentation Rate (ESR)
- Less specific than CRP
- May remain elevated longer during recovery
Blood Cultures
Positive yield is low (2-5%) in uncomplicated cellulitis
Indicated for:
- Patients with systemic toxicity (fever >38ยฐC, rigors, hypotension)
- Immunocompromised patients
- Suspected bacteraemia
- Severe cellulitis requiring hospitalisation
- Failed outpatient antibiotic therapy
Additional Blood Tests
Essential
Blood Glucose
- Check in all patients to exclude diabetes
- Essential in diabetic patients for glycaemic control assessment
Essential
Renal Function (eGFR, creatinine)
- Required before prescribing certain antibiotics
- Monitor in patients receiving nephrotoxic agents
Available
Liver Function Tests
- If considering clindamycin or other hepatically metabolised antibiotics
- Baseline measurement in severe infections
Microbiological Investigations
Swab Culture
Surface Swabs: Generally not recommended for intact skin cellulitis. Low diagnostic yield and may grow colonising organisms rather than causative pathogens.
Available
Wound Swabs
Indicated for:
- Open wounds, ulcers, or abscesses
- Purulent discharge present
- Atypical organisms suspected
- Failed initial antibiotic therapy
- Immunocompromised patients
Tissue Sampling
Specialist
Needle Aspiration
- Limited utility in typical cellulitis
- Consider in unusual presentations or treatment failures
- Aspirate from leading edge of erythema
- Low diagnostic yield (20-30%)
Specialist
Punch Biopsy
Reserved for:
- Atypical presentations
- Suspected malignancy
- Chronic non-healing lesions
- Unusual pathogens suspected
Specialised Cultures
Specialist
Mycobacterial Culture
- Chronic, indolent infections
- Atypical presentation
- Immunocompromised patients
- Travel history to endemic areas
Specialist
Fungal Culture
- Chronic infections
- Tropical/subtropical exposure
- Immunocompromised patients
Imaging Studies
Plain Radiographs
Indicated for:
- Suspected underlying osteomyelitis
- Foreign body suspected
- Gas-forming organisms (crepitus present)
- Diabetic foot infections
- Chronic ulceration overlying bone
Radiographic Signs
- Soft tissue swelling and oedema
- Gas in soft tissues (necrotising infection)
- Underlying bone changes (osteomyelitis)
- Foreign bodies
Ultrasound
Point-of-care ultrasound benefits
- Differentiate cellulitis from abscess
- Identify fluid collections requiring drainage
- Guide aspiration procedures
- Assess soft tissue involvement
Indications
- Suspected abscess formation
- Fluctuant areas on examination
- Treatment failure
- Guiding intervention procedures
Computed Tomography (CT)
CT with contrast indicated for:
- Suspected necrotising fasciitis
- Deep space infections
- Suspected underlying osteomyelitis
- Treatment failure with concern for complications
- Immunocompromised patients with severe infection
CT findings suggestive of necrotising infection:
- Gas in fascial planes
- Fascial thickening and enhancement
- Fluid collections in deep fascial planes
- Absence of enhancement (tissue necrosis)
Magnetic Resonance Imaging (MRI)
Most sensitive imaging for:
- Early osteomyelitis detection
- Deep space infections
- Necrotising fasciitis
- Distinguishing cellulitis from deeper infections
MRI Findings
- T2 hyperintensity in affected tissues
- Enhancement patterns distinguish cellulitis from necrotising infection
- Bone marrow oedema (osteomyelitis)
- Fascial involvement assessment
Special Populations
- Higher prevalence of Group A Streptococcal infections
- Consider throat swab if pharyngitis present
- Screen for rheumatic heart disease risk factors
- Blood cultures more frequently indicated due to higher bacteraemia risk
Diabetic Patients
Essential investigations:
- Blood glucose and HbA1c
- Foot X-rays if lower limb involvement
- Vascular assessment if peripheral disease suspected
- More aggressive microbiological sampling
- Consider osteomyelitis earlier in course
Immunocompromised Patients
Additional considerations:
- Blood cultures routinely indicated
- Tissue sampling for culture more frequently required
- Consider atypical pathogens
- Imaging studies earlier in course
- Fungal and mycobacterial cultures if indicated
Laboratory Reference Ranges
| Parameter | Normal Range | Action Required |
|---|---|---|
| White Cell Count | 4.0-11.0 ร 10โน/L | >15.0 suggests severe infection |
| CRP | <3.0 mg/L | >50 mg/L suggests bacterial infection |
| Neutrophils | 2.0-7.5 ร 10โน/L | >10.0 suggests severe infection |
| Blood Glucose | 3.9-7.8 mmol/L | >11.1 mmol/L requires management |
Investigation Limitations
False Negatives
- Normal inflammatory markers do not exclude infection
- Negative cultures in presence of clinical cellulitis
- Early infection may not show laboratory abnormalities
False Positives
- Elevated inflammatory markers from other causes
- Colonising organisms on wound cultures
- Non-infectious causes of inflammation
Cost-Effective Investigation Strategy
1
Uncomplicated cellulitis (outpatient)
- Clinical diagnosis sufficient
- No routine laboratory tests required
- Blood glucose screening
2
Complicated cellulitis (inpatient)
- FBC, CRP, renal function
- Blood cultures if systemically unwell
- Imaging if complications suspected
- Microbiological sampling of open wounds
3
Treatment failure
- Review initial diagnosis
- Blood cultures
- Wound/tissue sampling
- Consider imaging studies
- Specialist consultation
Treatment
General Principles
The management of cellulitis involves early recognition, appropriate antibiotic therapy, supportive care, and treatment of underlying predisposing factors. Treatment decisions should be guided by severity assessment, patient risk factors, and local antimicrobial resistance patterns.
Risk Stratification and Setting of Care
Class I
Mild - Outpatient Management
- Systemically well patients
- Small area of involvement (<10% body surface area)
- No systemic toxicity
- Immunocompetent
- Able to take oral medications
- Reliable follow-up available
Class II
Moderate - Consider Inpatient Management
- Systemically unwell but stable
- Larger area involvement
- Failed outpatient therapy
- Immunocompromised patients
- Significant comorbidities (diabetes, cardiovascular disease, chronic renal disease)
- Cellulitis of face, hands, or genitalia
Class III-IV
Severe - Inpatient Management
- Systemic toxicity or sepsis
- Rapidly progressive infection
- Necrotizing soft tissue infection suspected
- Immunosuppression
- Significant comorbidities with poor functional status
- Failed previous antibiotic therapy
Antibiotic Therapy
Mild Cellulitis (Class I) - Oral Therapy
First-line options:
Flucloxacillin
(Fluclox)
Adult Dose:
500mg
Route:
Oral
Frequency:
6 hourly
Duration:
5-10 days
Renal Adjustment:
Reduce frequency in severe renal impairment
PBS Status:
โ PBS General Benefit
Cephalexin
(Keflex)
Adult Dose:
500mg
Route:
Oral
Frequency:
6 hourly
Duration:
5-10 days
Renal Adjustment:
250-500mg every 8-12 hours if CrCl 30-60 mL/min; 250-500mg every 12-24 hours if CrCl <30 mL/min
PBS Status:
โ PBS General Benefit
Penicillin allergy (non-severe):
Cephalexin
(Keflex)
Adult Dose:
500mg (if no history of severe reaction)
Route:
Oral
Frequency:
6 hourly
Duration:
5-10 days
PBS Status:
โ PBS General Benefit
Severe penicillin allergy:
Clindamycin
(Cleocin)
Adult Dose:
300-450mg
Route:
Oral
Frequency:
8 hourly
Duration:
5-10 days
Renal Adjustment:
No adjustment required
PBS Status:
โ PBS Restricted Benefit
Trimethoprim-sulfamethoxazole
(Bactrim)
Adult Dose:
160/800mg
Route:
Oral
Frequency:
12 hourly
Duration:
5-10 days
Renal Adjustment:
Avoid if CrCl <15 mL/min
PBS Status:
โ PBS General Benefit
Moderate to Severe Cellulitis (Class II-IV) - Intravenous Therapy
First-line options:
Flucloxacillin
Adult Dose:
2g
Route:
IV
Frequency:
6 hourly
Renal Adjustment:
No adjustment for mild-moderate impairment; reduce frequency in severe impairment
PBS Status:
โ PBS General Benefit
Cefazolin
(Kefzol)
Adult Dose:
2g
Route:
IV
Frequency:
8 hourly
Renal Adjustment:
1-2g every 12 hours if CrCl 35-54 mL/min; 1g every 12-24 hours if CrCl 10-34 mL/min
PBS Status:
โ PBS Authority Required
Penicillin allergy:
Clindamycin
Adult Dose:
600mg
Route:
IV
Frequency:
8 hourly
Renal Adjustment:
No adjustment required
PBS Status:
โ PBS Restricted Benefit
Vancomycin
Adult Dose:
Loading dose 25-30mg/kg, then 15-20mg/kg
Route:
IV
Frequency:
12 hourly (adjust based on levels)
Renal Adjustment:
Dose reduction and/or extended intervals based on CrCl and levels
PBS Status:
โ PBS Authority Required
Special Circumstances
MRSA Risk Factors Present:
- Previous MRSA infection
- Recent hospitalization
- Healthcare exposure
- Injection drug use
- Poor response to beta-lactam therapy
Add or substitute:
Vancomycin
Dosing:
As above
Lincomycin
Adult Dose:
600mg
Route:
IV
Frequency:
12 hourly
Renal Adjustment:
Reduce dose in moderate to severe renal impairment
PBS Status:
โ PBS Authority Required
Diabetic Foot Cellulitis:
Consider broader spectrum coverage for mixed aerobic/anaerobic flora:
Amoxicillin-clavulanate
(Augmentin)
Adult Dose:
875/125mg oral, 12 hourly OR 1.2g IV, 8 hourly
Renal Adjustment:
Reduce frequency based on CrCl
PBS Status:
โ PBS General Benefit
Necrotizing Fasciitis (Emergency):
Immediate surgical consultation required
Immediate surgical consultation required
Benzylpenicillin + Clindamycin
Adult Dose:
Benzylpenicillin 2.4g IV 4 hourly PLUS Clindamycin 600mg IV 8 hourly
Alternative: Vancomycin + Clindamycin
Adult Dose:
Vancomycin as above PLUS Clindamycin as above
Aboriginal and Torres Strait Islander Considerations
- Higher rates of MRSA colonization and infection
- Consider MRSA coverage earlier in treatment course
- Group A Streptococcal infections may be more severe
- Address underlying conditions (diabetes, chronic kidney disease)
- Ensure culturally appropriate care and communication
- Consider social determinants affecting medication compliance
Duration of Therapy
Uncomplicated cellulitis
Oral therapy: 5-10 days
IV therapy: Switch to oral when clinically improving (typically 2-3 days)
Total duration: 7-10 days
IV therapy: Switch to oral when clinically improving (typically 2-3 days)
Total duration: 7-10 days
Complicated cellulitis
10-14 days total therapy
IV therapy until clinically stable, then switch to oral
IV therapy until clinically stable, then switch to oral
Severe or necrotizing infection
14-21 days or longer depending on response
Prolonged IV therapy may be required
Prolonged IV therapy may be required
Supportive Care
Pain Management
Paracetamol
Adult Dose:
1g
Route:
Oral/IV
Frequency:
6 hourly (maximum 4g/24 hours)
Ibuprofen
Adult Dose:
400mg
Route:
Oral
Frequency:
8 hourly (if no contraindications)
Avoid aspirin in acute infection
Local Care
- Elevation of affected limb
- Cool compresses for comfort
- Gentle range of motion exercises
- Avoid tight footwear or clothing
Fluid Management
- Adequate hydration
- Monitor for signs of dehydration or fluid overload
- IV fluids if unable to maintain oral intake
Treatment of Underlying Conditions
1
Diabetes Mellitus
- Optimize glycemic control
- HbA1c target <7% (53 mmol/mol) when clinically appropriate
- Monitor for diabetic complications
2
Venous Insufficiency
- Compression therapy once acute infection resolved
- Leg elevation
- Treatment of underlying venous disease
3
Lymphedema
- Appropriate compression garments
- Manual lymphatic drainage (post-acute phase)
- Skin hygiene education
4
Tinea Pedis
Topical antifungals:
- Terbinafine cream: Apply twice daily for 2-4 weeks
- Clotrimazole cream: Apply twice daily for 4 weeks
Monitoring and Follow-up
Outpatient Monitoring
- Clinical review at 24-48 hours
- Assessment of response to therapy
- Medication compliance and tolerability
- Signs of progression or complications
Inpatient Monitoring
- Daily clinical assessment
- Temperature, heart rate, blood pressure
- White cell count and inflammatory markers
- Renal function (especially with vancomycin)
- Mark borders of erythema to assess progression
Response to Therapy
Expected improvements within 48-72 hours:
- Reduction in erythema and swelling
- Decreased pain and tenderness
- Improvement in systemic symptoms
- Normalization of vital signs
Poor response indicators:
- Expanding erythema despite 48-72 hours of appropriate therapy
- Development of systemic toxicity
- New areas of involvement
- Fluctuance or crepitus
Treatment Failure
1
Reassessment Required
- Confirm diagnosis (rule out mimics)
- Consider resistant organisms (MRSA, gram-negative bacteria)
- Assess for complications (abscess, necrotizing infection)
- Review medication compliance
- Consider drug levels if using vancomycin
2
Management Options
- Change antibiotic class
- Add MRSA coverage
- Broaden spectrum for gram-negative coverage
- Surgical consultation for drainage or debridement
- Imaging to exclude deeper infection
Specific Populations
Pregnancy
Safe options:
Amoxicillin-clavulanate: 875/125mg, oral, 12 hourly
Cephalexin: 500mg, oral, 6 hourly
Cefazolin: 2g, IV, 8 hourly
Avoid: Trimethoprim-sulfamethoxazole (especially first trimester), Clindamycin (use with caution)
Elderly Patients
- Consider renal function for dosing adjustments
- Monitor for drug interactions
- Assess for frailty and functional decline
- Consider broader spectrum if immunocompromised
Immunocompromised Patients
- Lower threshold for hospital admission
- Broader spectrum antibiotics
- Consider fungal infections
- Infectious diseases consultation
- Extended duration of therapy
Prevention of Recurrence
Risk Factor Modification
- Optimize diabetes control
- Treat underlying dermatologic conditions
- Address lymphedema and venous insufficiency
- Maintain good skin hygiene
- Appropriate wound care
Prophylactic Antibiotics
Consider for patients with recurrent cellulitis (โฅ3 episodes per year):
Benzathine penicillin G
Adult Dose:
1.2 million units
Route:
IM
Frequency:
Monthly
Erythromycin
Adult Dose:
250mg
Route:
Oral
Frequency:
12 hourly (long-term)
PBS Status:
โ PBS Authority Required for long-term prophylaxis
Quality Indicators
- Time to appropriate antibiotic therapy
- Clinical improvement within 72 hours
- Length of hospital stay for admitted patients
- Rate of treatment failure requiring change in therapy
- 30-day readmission rates
- Patient satisfaction with care
Antimicrobial Stewardship
Antimicrobial stewardship in cellulitis management focuses on optimising antibiotic use to improve patient outcomes while minimising antimicrobial resistance and adverse effects. Key principles include right drug, right dose, right duration, and right route.
1
Clinical Assessment Priority
- Distinguish cellulitis from mimics (venous eczema, lipodermatosclerosis, contact dermatitis)
- Identify purulent vs non-purulent cellulitis to guide empirical therapy
- Assess severity using clinical criteria rather than reflexive broad-spectrum therapy
- Consider host factors: immunocompromise, diabetes, peripheral vascular disease
2
Microbiological Sampling Strategy
- Blood cultures indicated for severe cellulitis, systemic toxicity, or immunocompromised patients
- Wound culture only if purulent discharge present
- Avoid routine swabbing of non-purulent cellulitis
- Consider tissue biopsy/aspirate for atypical presentations or treatment failure
Empirical Therapy Selection
First-Line Oral Therapy (Mild-Moderate Cellulitis)
Target Group A Streptococcus and Staphylococcus aureus (MSSA):
Flucloxacillin
Preferred Option
Adult Dose:
500mg PO QID
Duration:
5-7 days
Renal Adjustment:
No adjustment needed for mild-moderate impairment
PBS Status:
โ PBS General Benefit
Cephalexin
Preferred Option
Adult Dose:
500mg PO QID
Duration:
5-7 days
Renal Adjustment:
Reduce dose if eGFR <50 mL/min/1.73mยฒ
PBS Status:
โ PBS General Benefit
Clindamycin
Penicillin Allergy
Adult Dose:
450mg PO QID
Duration:
5-7 days
Monitoring:
Monitor for C. difficile-associated diarrhoea
PBS Status:
โ PBS General Benefit
Erythromycin
If local resistance acceptable
Adult Dose:
500mg PO QID
Duration:
5-7 days
PBS Status:
โ PBS General Benefit
Intravenous Therapy (Severe Cellulitis)
Flucloxacillin
First-Line
Adult Dose:
2g IV QID
Switch to Oral:
When clinically improving (48-72 hours)
PBS Status:
โ PBS General Benefit
Clindamycin
Penicillin Allergy
Adult Dose:
600mg IV TDS
PBS Status:
โ PBS General Benefit
Vancomycin
Penicillin Allergy
Loading Dose:
25-30mg/kg
Maintenance:
15-20mg/kg BD
Renal Adjustment:
Monitor levels, adjust based on function
PBS Status:
โ PBS Authority Required
MRSA Considerations
Risk Factors for MRSA:
- Previous MRSA infection/colonisation
- Recent hospitalisation or residential care
- Intravenous drug use
- Chronic wounds or indwelling devices
- Treatment failure with beta-lactam therapy
MRSA-Active Therapy
Clindamycin
Oral MRSA (if susceptible)
Adult Dose:
450mg PO QID
PBS Status:
โ PBS General Benefit
Trimethoprim-sulfamethoxazole
Oral MRSA
Adult Dose:
160/800mg PO BD
Note:
Add clindamycin if streptococcal cover needed
PBS Status:
โ PBS General Benefit
Vancomycin
IV MRSA
Adult Dose:
15-20mg/kg BD
Target Trough:
15-20mg/L
Monitoring:
Renal function and vancomycin levels
PBS Status:
โ PBS Authority Required
Lincomycin
Alternative to vancomycin
Adult Dose:
600mg IV TDS
PBS Status:
โ PBS Authority Required
Treatment Duration Optimisation
STANDARD DURATION
Treatment Duration
- Mild-moderate cellulitis: 5-7 days oral therapy
- Severe cellulitis: 5-10 days total (IV + oral sequential)
- Extend duration only for slow clinical response or complications
24-48 hours
Cessation of spreading erythema
48-72 hours
Reduction in warmth and swelling
Early response
Resolution of systemic symptoms (fever, malaise)
Follow-up
Normalisation of inflammatory markers if initially elevated
Early Switch Criteria (IV to Oral):
- Afebrile for 24 hours
- Ability to tolerate oral medications
- Cessation of cellulitis progression
- Adequate oral bioavailability for chosen agent
Special Populations
ATSI Health Considerations
Higher rates of diabetes and renal disease affecting drug choice
Consider social determinants affecting adherence
Involve Aboriginal Health Workers in education and follow-up
Screen for concurrent conditions (diabetes, renal disease)
Diabetes Mellitus
Increased risk of MRSA and gram-negative organisms
Consider broader spectrum if severe or recurrent
Assess for underlying osteomyelitis if overlying bone involvement
Optimise glycaemic control alongside antibiotic therapy
Renal Impairment
Adjust doses for renally cleared antibiotics
Monitor for accumulation of active metabolites
Avoid nephrotoxic combinations where possible
Consider alternative agents if significant impairment
Quality Indicators and Monitoring
Process Indicators
- Proportion of patients receiving appropriate empirical therapy
- Time to first antibiotic dose for severe cellulitis
- Appropriate duration of therapy (avoid prolonged courses)
- IV to oral conversion rates and timing
Outcome Indicators
- Clinical cure rates at end of therapy
- 30-day recurrence rates
- Adverse drug events
- Length of stay for hospitalised patients
Antimicrobial Resistance Monitoring:
- Local MRSA prevalence in skin and soft tissue infections
- Clindamycin resistance rates
- Macrolide resistance patterns
- Beta-lactam resistance trends
Antimicrobial Allergy Management
1
Penicillin Allergy Assessment
- Distinguish true allergy from intolerance
- Consider penicillin allergy testing for recurrent infections
- Document reaction type and severity
- Review need for allergy label if remote history
2
Alternative Pathways
- First-generation cephalosporins safe in most penicillin-allergic patients
- Reserve clindamycin for true beta-lactam allergy
- Consider infectious diseases consultation for complex allergy histories
Stewardship Interventions
1
Prescriber Education
- Regular updates on local resistance patterns
- Guidelines on empirical therapy selection
- Duration of therapy recommendations
- Recognition of cellulitis mimics
2
Prospective Audit and Feedback
- Review of broad-spectrum antibiotic use
- Assessment of treatment duration appropriateness
- Feedback on switch therapy compliance
- Monitoring of patient outcomes
3
Clinical Decision Support
- Electronic prescribing alerts for prolonged therapy
- Automatic stop dates on antibiotic orders
- Allergy checking systems
- Drug interaction screening
Special Populations
Pregnancy and Breastfeeding
Pregnancy
Cellulitis management follows similar principles with antimicrobial modifications
Amoxicillin-clavulanate
(Augmentin)
Adult Dose
875/125mg
Route
PO
Frequency
12-hourly
Duration
5-10 days
PBS Status
โ PBS General Benefit
Benzylpenicillin + Flucloxacillin
(Penicillin G)
Adult Dose
1.2g + 2g
Route
IV
Frequency
6-hourly
PBS Status
โ PBS General Benefit
Cephalexin
(Keflex)
Adult Dose
500mg
Route
PO
Frequency
6-hourly
PBS Status
โ PBS General Benefit
Avoid: Trimethoprim-sulfamethoxazole (especially first trimester), fluoroquinolones, tetracyclines
Use cephalexin only if no anaphylaxis history to penicillins
Use cephalexin only if no anaphylaxis history to penicillins
Consider venous thromboembolism risk in immobilised pregnant women with severe cellulitis
Breastfeeding
Compatible antibiotics: Flucloxacillin, amoxicillin-clavulanate, cephalexin, clindamycin
Monitor infant for diarrhea or candidiasis
Clindamycin
(Dalacin C)
Adult Dose
450mg
Route
PO
Frequency
8-hourly
PBS Status
โ PBS Authority Required
Paediatric Population
Neonates (0-28 days)
Hospital admission mandatory
Flucloxacillin + Gentamicin
Paediatric Dose
50mg/kg/day + 5mg/kg
Route
IV
Frequency
4 divided doses + daily
Duration
7-10 days
PBS Status
โ PBS General Benefit
Infants and Children (>28 days)
Mild-Moderate
Outpatient Treatment
Community management
Severe
Inpatient Treatment
Hospital admission
Flucloxacillin
(Flopen)
Paediatric Dose
25-50mg/kg/day (max 2g/day)
Route
PO (mild) / IV (severe 50mg/kg/day max 8g)
Frequency
4 divided doses
PBS Status
โ PBS General Benefit
Clindamycin
Paediatric Dose
20-30mg/kg/day
Route
PO/IV
Frequency
3 divided doses
PBS Status
โ PBS Authority Required
Special Paediatric Considerations:
โข Higher risk of necrotising fasciitis in children
โข Consider Group A Streptococcus in rapidly progressive cellulitis
โข Monitor for complications: septic arthritis, osteomyelitis
โข Weight-based dosing adjustments for renal impairment
โข Higher risk of necrotising fasciitis in children
โข Consider Group A Streptococcus in rapidly progressive cellulitis
โข Monitor for complications: septic arthritis, osteomyelitis
โข Weight-based dosing adjustments for renal impairment
Elderly Patients (โฅ65 years)
Risk Assessment
- Higher mortality and complication rates
- Increased risk of Gram-negative pathogens
- Comorbidities impact treatment choices and outcomes
- Polypharmacy considerations for drug interactions
Amoxicillin-clavulanate
Adult Dose
875/125mg
Route
PO
Frequency
12-hourly
PBS Status
โ PBS General Benefit
Piperacillin-tazobactam
(Tazocin)
Adult Dose
4.5g
Route
IV
Frequency
8-hourly
PBS Status
โ PBS Authority Required
Monitoring and Complications:
โข Daily assessment for clinical deterioration
โข Renal function monitoring (creatinine, eGFR)
โข Falls risk increased with IV therapy
โข Consider shorter courses if clinically appropriate
โข Daily assessment for clinical deterioration
โข Renal function monitoring (creatinine, eGFR)
โข Falls risk increased with IV therapy
โข Consider shorter courses if clinically appropriate
Immunocompromised Patients
Risk Categories
- Diabetes mellitus with poor glycaemic control
- Chronic kidney disease (eGFR <30 mL/min/1.73mยฒ)
- Active malignancy or chemotherapy
- Solid organ transplant recipients
- HIV infection (CD4 <200 cells/ฮผL)
- Chronic corticosteroid use (>20mg prednisolone daily >14 days)
- Biologic immunosuppressive therapy
Vancomycin
(Vancocin)
Adult Dose
25-30mg/kg loading, then 15-20mg/kg
Route
IV
Frequency
12-hourly
PBS Status
โ PBS Authority Required
Special Considerations:
โข Fungal cellulitis possible in severely immunocompromised
โข Atypical organisms: Pseudomonas, Enterobacteriaceae
โข Prolonged treatment courses often required (10-14 days)
โข Target vancomycin trough levels 15-20mg/L for serious infection
โข Fungal cellulitis possible in severely immunocompromised
โข Atypical organisms: Pseudomonas, Enterobacteriaceae
โข Prolonged treatment courses often required (10-14 days)
โข Target vancomycin trough levels 15-20mg/L for serious infection
Aboriginal and Torres Strait Islander Peoples
Epidemiological Considerations
- Higher incidence of cellulitis and complications
- Increased prevalence of diabetes and chronic kidney disease
- Social determinants affecting access to care
- Higher rates of MRSA colonisation in some communities
Clinical Approach
- Cultural safety and communication preferences
- Family-centred care approach
- Consider transportation and accommodation barriers
- Early involvement of Aboriginal Health Workers/Practitioners
Trimethoprim-sulfamethoxazole
(Bactrim)
Adult Dose
160/800mg
Route
PO
Frequency
12-hourly
PBS Status
โ PBS General Benefit
Discharge Planning:
โข Ensure adequate follow-up arrangements
โข Consider directly observed therapy if adherence concerns
โข Coordinate with primary healthcare services
โข Address underlying risk factors (diabetes management, skin care)
โข Ensure adequate follow-up arrangements
โข Consider directly observed therapy if adherence concerns
โข Coordinate with primary healthcare services
โข Address underlying risk factors (diabetes management, skin care)
Chronic Kidney Disease
Dosing Adjustments by eGFR
eGFR 30-60
Mild-Moderate CKD
Flucloxacillin: Standard dosing
Amoxicillin-clavulanate: No adjustment
Cephalexin: 500mg PO 12-hourly
Amoxicillin-clavulanate: No adjustment
Cephalexin: 500mg PO 12-hourly
eGFR 15-30
Moderate-Severe CKD
Flucloxacillin: 1g IV 8-hourly
Amoxicillin-clavulanate: 875/125mg daily
Avoid gentamicin
Amoxicillin-clavulanate: 875/125mg daily
Avoid gentamicin
eGFR <15
Severe CKD/Dialysis
Nephrology consultation recommended
Flucloxacillin: 1g IV 12-hourly
Consider alternative agents
Flucloxacillin: 1g IV 12-hourly
Consider alternative agents
Monitoring Requirements:
โข Baseline and serial creatinine measurements
โข Avoid nephrotoxic combinations
โข Ensure adequate hydration
โข Consider drug level monitoring for renally cleared antibiotics
โข Baseline and serial creatinine measurements
โข Avoid nephrotoxic combinations
โข Ensure adequate hydration
โข Consider drug level monitoring for renally cleared antibiotics
Follow-Up & Prevention
Clinical Follow-Up Schedule
Outpatient Follow-Up
- Review within 24-48 hours for mild-moderate cellulitis
- Review within 12-24 hours if patient has:
- Diabetes mellitus
- Immunocompromised state
- Peripheral vascular disease
- Lymphoedema
- Previous recurrent cellulitis
- Daily review for severe cellulitis managed as outpatient
Return to ED immediately if:
- Spreading erythema despite treatment
- Systemic symptoms develop
- Failure to improve after 48-72 hours appropriate therapy
Inpatient Follow-Up
1
Daily Clinical Assessment
Document erythema margins (mark with pen), temperature and vital signs, response to therapy, development complications
2
Consider Discharge When
Afebrile for 24 hours, clinically improving, able to tolerate oral antibiotics, social circumstances appropriate
Treatment Response Assessment
24-48 hours
Initial response: improvement expected
48-72 hours
Significant improvement expected
5-10 days
Resolution of acute inflammation
2-4 weeks
Complete healing (depending on severity)
Failure to Respond - Consider:
- Incorrect diagnosis (DVT, necrotising fasciitis, inflammatory conditions)
- Resistant organisms (MRSA, gram-negative bacteria)
- Inadequate antibiotic penetration
- Underlying abscess or foreign body
- Immunocompromised state
- Non-compliance with therapy
Prevention Strategies
Primary Prevention
- Maintain good skin hygiene
- Moisturise dry skin regularly
- Treat fungal infections promptly (tinea pedis, onychomycosis)
- Appropriate wound care for minor trauma
- Protective footwear in high-risk environments
- Sun protection to prevent skin damage
Secondary Prevention for Recurrent Cellulitis
Address predisposing factors:
- Optimise diabetes control (HbA1c <7%)
- Weight management if obese
- Treat venous insufficiency/lymphoedema
- Manage peripheral vascular disease
Skin care measures:
- Daily inspection of high-risk areas
- Regular moisturising
- Prompt treatment of minor wounds
- Antifungal treatment for athlete's foot
Prophylactic Antibiotics
Consider for patients with โฅ3 episodes cellulitis per year:
Phenoxymethylpenicillin (Penicillin V)
First-line prophylaxis
Adult Dose:
250mg
Route:
Oral
Frequency:
Twice daily
Duration:
Long-term
Renal Adjustment:
Reduce dose if CrCl <10 mL/min
PBS Status:
โ PBS General Benefit
Erythromycin (Eryc)
Penicillin allergy
Adult Dose:
250mg
Route:
Oral
Frequency:
Twice daily
Duration:
Long-term
Renal Adjustment:
No adjustment required
PBS Status:
โ PBS General Benefit
Roxithromycin (Rulide)
Alternative option
Adult Dose:
150mg
Route:
Oral
Frequency:
Daily
Duration:
Long-term
PBS Status:
โ PBS General Benefit
Clindamycin (Dalacin C)
Alternative option
Adult Dose:
150mg
Route:
Oral
Frequency:
Daily
Duration:
Long-term
PBS Status:
โ PBS Restricted Benefit
Special Populations
Aboriginal and Torres Strait Islander Patients
- Higher rates of skin and soft tissue infections
- Consider social determinants affecting follow-up
- Ensure culturally appropriate care coordination
- Address overcrowding and hygiene challenges
- Screen for underlying conditions (diabetes, renal disease)
- Consider longer antibiotic courses if adherence challenging
Diabetes Mellitus
- Foot cellulitis requires specialist input
- Monitor blood glucose control during acute illness
- Regular podiatry review
- Diabetes educator involvement for foot care education
- Annual diabetic foot assessment
Lymphoedema
- Compression therapy when acute infection settled
- Lymphatic drainage techniques
- Specialist lymphoedema clinic referral
- Skin care education critical
Immunocompromised Patients
- Infectious diseases consultation
- Consider atypical organisms
- Prolonged antibiotic courses may be required
- Monitor for opportunistic infections
Complications Monitoring
Early Complications (0-7 days)
- Necrotising fasciitis
- Abscess formation
- Bacteraemia/sepsis
- Acute kidney injury
Late Complications (>7 days)
- Post-infectious glomerulonephritis (Group A Streptococcus)
- Chronic lymphoedema
- Recurrent cellulitis
- Scarring and skin changes
Patient Education
Key Messages:
- Complete full course of antibiotics even if feeling better
- Recognise early signs of recurrence
- Importance of wound care and skin hygiene
- When to seek urgent medical attention
- Risk factor modification
Red Flag Symptoms to Report:
- Rapid spread of redness
- Black or dark blue discolouration
- Severe pain disproportionate to appearance
- High fever or feeling systemically unwell
- Blistering or skin breakdown
- Red streaks tracking up limb
Quality Indicators
Process Measures
- Proportion of patients with documented follow-up plan
- Antibiotic prescribing concordance with guidelines
- Time to appropriate antibiotic therapy
Outcome Measures
- Treatment failure rates
- Recurrence rates at 30 days and 12 months
- Hospital readmission rates
- Patient satisfaction scores
Documentation Requirements
Discharge Summary Should Include
- Diagnosis and severity assessment
- Antibiotic regimen and duration
- Follow-up arrangements
- Warning signs for patient
- Predisposing factors identified
- Preventive measures discussed
GP Communication
- Clinical findings and assessment
- Antimicrobial therapy details
- Duration of treatment
- Risk factors for recurrence
- Specialist referrals if indicated
References
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