Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets and reassess frequently.
- Plan definitive source control or disease‑specific therapy when indicated; document follow‑up and patient education.
Algorithm
- Determine purulent vs nonpurulent; drain abscesses.
- Start empiric antibiotics tailored to phenotype and risk factors; escalate for systemic toxicity.
- Address predisposing conditions; provide recurrence prevention plan.
Clinical Synopsis & Reasoning
Erythema, warmth, and tenderness of skin/subcutaneous tissue. Differentiate purulent vs nonpurulent cellulitis; drain abscesses and choose antibiotics considering MRSA risk. Address risk factors (tinea pedis, edema, venous stasis) to prevent recurrence.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced/procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|
| Clinical exam and ultrasound (abscess?) | Phenotype | Purulent vs nonpurulent | Guides therapy |
| Cultures (if purulent, severe, or immunocompromised) | Etiology | MRSA/MSSA/streptococci | Tailor therapy |
| Assess predisposing conditions (edema, tinea) | Prevention | Reduce recurrence | — |
High-Risk & Disposition Triggers
| Trigger | Why it matters | Action |
|---|
| Rapid progression/systemic toxicity | Severe infection | Admit; broad IV antibiotics; r/o NSTI |
| Facial/periorbital involvement | Complications | Specialty consults |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|
| Incision and drainage (purulent) | Source control | Immediate | Primary therapy for abscess | — |
| Cephalexin/Dicloxacillin (nonpurulent) or TMP‑SMX/Doxycycline/Clindamycin (purulent/MRSA risk) | Antibiotics | Hours | Empiric coverage | Adjust to culture |
| Elevation/compression and skin care | Adjunct | Days | Reduce edema and recurrence | — |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.
References
- IDSA SSTI guideline — Link