L03.0-3/L03.8-9
DESCRIPTION
A diffuse, spreading, acute infection within skin and soft tissues, commonly caused by streptococci and staphylococci.
Characterised by:
- oedema
- redness
- increased local temperature
- no suppuration
Frequently associated with lymphangitis and regional lymph node involvement.
Commonly occurs on the lower legs, but may occur elsewhere.
May follow minor trauma.
There may be significant systemic manifestations of infection:
- fever
- tachycardia
- hypotension
- chills
- delirium/altered mental state
May present as an acute fulminant or chronic condition.
GENERAL MEASURES
Elevate the affected limb to reduce swelling and discomfort.
MEDICINE TREATMENT
Children ≤ 7 years of age
- Cefalexin, oral, 12–25 mg/kg/dose 6 hourly for 5 days. See paediatric dosing tool.
OR
- Flucloxacillin, oral, 12–25 mg/kg/dose 6 hourly for 5 days. See paediatric dosing tool.
Children > 7 years of age and adults
- Cefalexin, oral, 500 mg 6 hourly for 5 days.
OR
- Flucloxacillin, oral, 500 mg 6 hourly for 5 days.
Severe penicillin allergy: Z88.0
Children:
- Macrolide, e.g.:
- Azithromycin, oral, 10 mg /kg/dose daily for 3 days. See paediatric dosing tool.
Adults
- Macrolide, e.g.:
- Azithromycin, oral, 500 mg daily for 3 days.
Severe cases:
Refer for parenteral antibiotics.
REFERRAL
Urgent
- Children who have significant pain, swelling or loss of function (to exclude osteomyelitis).
- Haemorrhagic bullae, gas in the tissues or gangrene.
- Extensive cellulitis.
- Recurrent cellulitis associated with underlying conditions, e.g. lymphoedema.
- Cellulitis with systemic manifestations, e.g. confusion, hypotension.
- Poorly controlled diabetic patients.
- Involvement of the hand, face and scalp
Non-urgent
- Inadequate response to initial antibiotic treatment.