ESBL: extended-spectrum beta-lactamase; IDU: intravenous drug use; MRSA: methicillin-resistant Staphylococcus aureus; MSSA: methicillin-sensitive Staphylococcus aureus; IV: intravenous.
* For patients with severe sepsis or immunocompromising condition who cannot take any beta-lactam agents, we suggest intravenous vancomycin plus either levofloxacin (750 mg IV once daily) or aztreonam (2 g IV every 6 to 8 hours).
¶ If a causative organism is identified, narrow antibiotics to target the pathogen as appropriate.
Δ For patients wtih lymphangitis, some UpToDate contributors would require additional criteria to warrant parenteral antibiotics.
◊ We generally consider healthcare exposures within 12 months (or antibiotic exposures within 6 months) of cellulitis to be risk factors for MRSA, although these time intervals are uncertain. A complete list of MRSA risk factors can be found in UpToDate content.
§ Five to six days of antibiotic therapy is generally adequate; extension up to 14 days may be warranted for severe infection or slow clinical response.
¥ The majority of patients with reported beta-lactam allergies can take a cephalosporin (refer to UpToDate content for details).
‡ We generally avoid clindamycin, if possible, due to risk of Clostridium difficile infection and the possibility of streptococcal and staphylococcal resistance (refer to UpToDate content for details).