Empirical therapy for cellulitis associated with hypotension, septic shock, severe pain, or rapid progression of systemic features or erythema

Broad-spectrum therapy is required initially for patients with cellulitis associated with hypotension, septic shock, severe pain or rapid progression of systemic features or erythema. For initial therapy, use the regimens in necrotising skin and soft tissue infections. Seek expert advice for ongoing therapy.

For patients with cellulitis who have sepsis or septic shock, start antibiotic therapy within 1 hour of presentation to medical care or, for ward-based patients, development of sepsis or septic shock. Antibiotics should be administered immediately after blood samples are taken for culture. For nonantibiotic management of sepsis or septic shock, see Resuscitation of patients with sepsis or septic shock.

For cellulitis associated with hypotension, septic shock, severe pain, or rapid progression of systemic features or erythema, the duration of therapy depends on the patient’s comorbidities, response to therapy, isolated pathogen, need for debridement, and presence of bacteraemia or complications of infection – seek expert advice.