CELLULITIS

Question 1

What is cellulitis?

Answer 1

• Break in skin and infection with S. aureus or Strep. Pyogenes.
• Transmitted by: contact with infected individual/objects (contagious).

Question 2

Erysipelas vs cellulitis

Answer 2

Erysipelas is a superficial infection, affecting the upper layers of the skin, while cellulitis affects the deeper tissues.

Lesions are more superficial in erysipelas and have a well-defined, raised margin.

Question 3

Symptoms of cellulitis

Answer 3

• Red skin
• Swelling
• Hot
• Pain
• Calor, dolor, tumor, rubor

Question 4

Eron classification

Answer 4

• Used to class severity
• Greater than class III – hospital admission.

Question 5

Class I

Answer 5

no signs of systemic toxicity or uncontrolled comorbidities
- Managed in primary care

Question 6

Class II

Answer 6

Class II – a person either systemically unwell or systemically well but with a comboribity
e.g. arterial disease, chronic venous insufficiency, morbid obesity
which may complicate or delay resolution of infection
- Suitable for short term (up to 48h) hospitalisation and discharge on outpatient parenteral abx therapy

Question 7

Class III

Answer 7

significant systemic upset
e.g. acute confusion, tachycardia, hypotension
or unstable comorbidities that may interfere with response to treatment or limb threatening infection due to vascular compromise

Question 8

Class IV

Answer 8

sepsis, or severe life-threatening infection
e.g. necrotising fasciitis
- Class III IV = urgent hospital admission

Question 9

Treatment

Answer 9

1. Flucloxacillin 0.5–1 g 4 times a day for 5–7 days then review.
2. Penicillin Allergy: Clarithromycin 500mg BD/ Erythromycin 500mg QDS/ Doxycycline 200mg on day 1, then 100mf OD (all for 5-7 days)

Question 10

Treatment if infection is near the eyes or nose

Answer 10

1. Co-Amoxiclav

   625mg TDS for 7 days then review
2. Penicillin Allergy: Clarithromycin AND metronidazole
   clarith 500mg BD + metro 400mg TDS for 7 days

Question 11

when may a trial of abx prophylaxis be considered for cellulitis or erysipelas

Answer 11

Pt treated in hospital or under specialist advice for at least 2 separate episodes in the previous 12 months

review every 6 months