Patient review, and modification and duration of therapy for cellulitis or erysipelas without systemic features

If local symptoms of cellulitis or erysipelas are worsening or not improving at 48 hours, reconsider the diagnosis, look for a drainable source of infection, and reconsider antibiotic choice (see Assessment of cellulitis and erysipelas and Aetiology of cellulitis and erysipelas). If reassessment does not change the diagnosis or empirical regimen, or a drainable source of infection is not located, consider switching to intravenous therapy(NICE), 2019.

The usual duration of antibiotic therapy is 5 days for patients with cellulitis or erysipelas without systemic features who have had substantial clinical improvement, even if mild signs of inflammation remain(NICE), 2019. It is common for patients to have residual signs of inflammation at the end of treatment. Advise patients to return for review after 5 days of therapy if symptoms are not improving; a longer course of 10 to 14 days may be considered(NICE), 2019.