Preventing recurrent cellulitis

Recurrent episodes of cellulitis are common. The risk and severity of recurrence increases proportionally to the number of previous episodes; for patients who have had 3 or more episodes, the 3-year risk for another episode is more than 50%Cannon, Dyer, 2018.

Examine patients with recurrent cellulitis for predisposing risk factors (eg tinea pedis, lymphoedema, varicose veins, peripheral vascular disease, diabetes, obesity, chronic lung disease, liver disease, rheumatological disorders) and address their managementCannon, Dyer, 2018Cannon, Rajakaruna, 2018.

For patients with recurrent cellulitis, compression therapy to address lymphoedema and other causes of leg swelling reduces recurrent episodes by more than 50%Webb, 2020; see Assessing patients with an ulcer or wound for more information.

Patients with persistent risk factors for recurrent cellulitis can be provided with a stand-by prescription for oral antibiotics (see Empirical therapy for cellulitis and erysipelas without systemic features) so they can start treatment as soon as symptoms develop.

For patients who have had 2 or more episodes of cellulitis, consider antibiotic prophylaxis, which prevents approximately 50% of recurrent episodes(NICE), 2019. Use(NICE), 2019Thomas, 2013:

The optimal duration of antibiotic prophylaxis is unclear and depends on the presence and management of predisposing risk factors (see above)Thomas, 2013.

For patients who report hypersensitivity to a penicillin, seek expert advice for prophylaxis regimens.