Diagnosis and management of cellulitis

Summary points

• Cellulitis episodes in the United States, the United Kingdom, and Australia have risen over the past decade, with an increase in community acquired meticillin resistant Staphylococcus aureus (CA-MRSA) cases of cellulitis in the US, and to a lesser extent the UK and Australia. Antibiotic resistant strains of CA-MRSA are already emerging

• Diagnosis is based on clinical findings with investigations lending weight to confirm or refute diagnosis

• Existing guidelines need revision, taking into consideration CA-MRSA and other emerging strains as well as using new clinical classification systems such as the Dundee criteria

• Use outpatient parenteral antibiotic therapy if available

• More randomised control trials assessing the management of predisposing factors and long term therapy for recurrent cellulitis are required

Sources and selection criteria

We searched PubMed and the Cochrane library for recent and clinically relevant cohort studies and randomised controlled trials on cellulitis, using the search terms “cellulitis”, “erysipelas”, “diagnosis”, “investigation”, “recurrence”, “complications” and “management”. For position statements and guidelines we consulted the British Lymphology Society (BLS), National Health Service Clinical Knowledge Summaries (CKS), Clinical Resource Efficiency Support Team (CREST), and Infectious Disease Society of America (IDSA).