First10EM - By Justin Morgenstern| - April 2, 2018
..."Summary
Putting this all together, I think it is pretty clear that oral antibiotics should be used for the vast majority of cellulitis patients. Even patients who have already been on oral antibiotics seem to fare great when randomized to cephalexin. (Aboltins 2015) In fact, oral antibiotics seem to be the right choice for almost every infectious disease that has been studied. That makes sense, considering that the bacterium living in your tissues remains ignorant of the antibiotic’s port of entry.
Clearly there are times when intravenous therapy is required. If a patient cannot swallow. If the required dose cannot be tolerated orally. If oral antibiotics cannot be absorbed, either because of the chemical structure of the antibiotic, or because of intestinal problems, which often occur in the critically ill. Or in emergent scenarios, when rapidly achieving peak antibiotic levels might matter. However, these represent a minority of clinical scenarios, especially when discussing cellulitis.
It is time that we dispel the magical thinking that surrounds IV antibiotics."