Letters Cellulitis

Treat all cases of cellulitis with anti-staphylococcal antibiotics

BMJ 2012; 345 doi: (Published 04 September 2012) Cite this as: BMJ 2012;345:e5876
  1. Nikolas Rae, ST3, infectious diseases1,
  2. Charis Marwick, consultant in infectious diseases1
  1. 1Ninewells Hospital, Dundee DD1 9SY, UK
  1. nikolas.rae{at}

In their clinical review of the management and treatment of cellulitis Phoenix and colleagues recommend different treatment on the basis of streptococcal and staphylococcal infection.1 However, clinically distinguishing between streptococcal and staphylococcal cellulitis is often impossible, so such recommendation is not helpful in clinical practice. All cases of cellulitis should be treated with an antibiotic with anti-staphylococcal activity, thus amoxicillin is inappropriate. This is supported by guidelines from both CREST (Clinical Resource Efficiency Support Team) and IDSA (Infectious Diseases Society of America),2 3 although Phoenix and colleagues state that amoxicillin is recommended empirical treatment in the CREST guidance.1

Cross sectional imaging is not essential in diagnosing necrotising fasciitis, which is mainly diagnosed clinically. Delays in obtaining imaging may lead to clinically significant deterioration and delay in definitive surgical treatment.2 3


Cite this as: BMJ 2012;345:e5876


  • Competing interests: None declared.