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Monday, May 3, 2021

Cellulitis Disposition

emDocs - May 3, 2021 - By Annette Mueller, Andrew Sweeny
Reviewed by: Mark Ramzy; Alex Koyfman; Brit Long
“Take Home Points
  • A lack of evidence-based guidance on disposition from the ED results in significant variability in treatment regimens. IDSA issued guidelines for the management of skin and soft tissue infections differentiate between mild, moderate and severe non-purulent cellulitis. Patients with ‘mild’ cases of cellulitis, without systemic signs of infection, are recommended for discharge with oral antibiotics.
  • The most prevalent reason for the admission of cellulitis patients is the recommendation of intravenous antibiotics for moderate to severe cellulitis per IDSA guidelines.
  • In addition, providers need to consider a long list of additional risk factors for outpatient treatment failure, including severe immunocompromise, kidney or liver disease, diabetes, previous MRSA exposure or cellulitis, inability to take oral medication, high risk for poor compliance, or previous outpatient treatment failure.
  • Two options that could be considered to reduce admissions are 1) outpatient treatment with intravenous antibiotic or 2) early substitution of IV with PO antibiotics for moderate to severe cases. However, both strategies have limitations and are currently not supported by generally accepted guidelines.”