Letters Cellulitis

Authors’ reply to Rae and Marwick, Halpern, and Basak

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5881 (Published 04 September 2012) Cite this as: BMJ 2012;345:e5881
  1. Gokulan Phoenix, core surgical trainee year 1 (London Deanery)1,
  2. Saroj Das, consultant vascular surgeon2,
  3. Meera Joshi, core surgical trainee year 1 (Oxford Deanery)3
  1. 1Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK
  2. 2Department of General Surgery, the Hillingdon Hospitals, London, UK
  3. 3Department of General Surgery, Wexham Park Hospital, Slough, UK
  1. gokulan.phoenix{at}nhs.net

We agree that it is impractical to distinguish between streptococcal and staphylococcal cellulitis.1 As we said in our review,2 flucloxacillin should be used to cover both organisms or when the organism is unknown. However, when organisms are isolated, especially in community acquired meticillin resistant Staphylococcus aureus (CA-MRSA), antibiotic treatment may need to be tailored.

A clinical diagnosis for necrotising fasciitis is not always straightforward. In type B and type C infections (more insidious onset) magnetic resonance imaging can confirm or refute diagnosis, as well as demarcate the extent of disease. …

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