Initial Antibiotic Therapy in Cellulitis and Necrotizing Fasciitis
| Setting | Organisms to be covered in addition to Streptococcus pyogenes and Staphylococcus aureus | Antibiotic therapy IV | |
|---|---|---|---|
| Not allergic to penicillin | Penicillin allergy | ||
Otherwise well Diabetes with foot ulcer | Strep. pyogenes is commonest causative organism, but Staph. aureus should also be covered if cellulitis is severe Gram-negative and anaerobic bacteria | Clarithromycin or clindamycin Clindamycin | |
| Setting | Organisms to be covered in addition to Streptococcus pyogenes and Staphylococcus aureus | Antibiotic therapy IV | |
|---|---|---|---|
| Not allergic to penicillin | Penicillin allergy | ||
Possible necrotizing fasciitis Hospital- or nursing- home acquired Human bite | Streptococci spp. Gram-negative and anaerobic bacteria Meticillin-resistant Staph. aureus (MRSA) Mixed oral flora including anaerobes | Piperacillin/tazobactam Vancomycin or teicoplanin Co-amoxiclav | Vancomycin or teicoplanin + gentamicin + metronidazole Vancomycin or teicoplanin Tetracycline + metronidazole |