Cellulitis

Question 1

What is cellulitis?

Answer 1

A bacterial infection which affects the dermis and the deeper subcut tissues

Question 2

What organisms cause cellulitis?

Answer 2

• Strep pyogenes
• Staph aureus

Question 3

How does cellulitis present?

Answer 3

• Common on the shins
• Usually unilateral
• Erythema with well defined margins
• Blisters and bullae may be present in severe disease
• Swelling
• Fever, malaise, nausea

Question 4

How is cellulitis classified?

Answer 4

Using the Eron classification

Question 5

What is the Eron Classification?

Answer 5

I - No systemic toxicity and no uncontrolled co-morbidities
II - Systemically unwell or systemically well with co-morbidity
III - Significant systemic upset e.g. confusion, tachycardia or a limb-threatening infection
IV - Sepsis syndrome or severe life-threatening infection

Question 6

What is NICE recommendations for admission for IV Abx?

Answer 6

• Eron Class III or IV
• Severe/deteriorating cellulitis
• Under 1s
• Immunocompromised
• Significant lymphoedema
• Facial cellulitis

Question 7

What is the management of cellulitis?

Answer 7

Eron I
- Oral Flucloxacillin is first line
- Clarithromycin/Doxycycline for penicillin allergy (Erythromycin for pregnancy)

Eron II
- Oral may be sufficient
- Check clinical pictire

Eron III-IV
- Admission
- Oral/IV Co-Amoxiclav, Clindamycin or 3rd gen Cephalosporin