Table 1.

Empiric antibiotic selection for nonpurulent and purulent cellulitis

ANTIBIOTICUSUAL ADULT DOSEPEDIATRIC DOSE
Nonpurulent cellulitis
Empiric therapy for group A streptococcus
  • Cephalexin500 mg orally, 4 times daily50–100 mg/kg orally, divided 4 times daily
Empiric therapy for group A streptococcus and MRSA
  • Cephalexin and 1 of the following:

  • -TMP-SMX* or

  • -doxycycline†

500 mg orally, 4 times daily, and 1 of the following:

  • 1 to 2 DS TMP-SMX tablets orally, twice daily,‡ or

  • 100 mg of doxycycline orally, twice daily

50–100 mg/kg orally, divided 4 times daily, and 1 of the following:

  • 8 to 12 mg/kg of TMP-SMX orally, divided twice daily, or

  • 4 mg/kg of doxycycline orally, divided twice daily

Purulent cellulitis
Empiric therapy for MSSA
  • Cephalexin500 mg orally, 4 times daily50–100 mg/kg orally, divided 4 times daily
  • Cloxacillin500 mg orally, 4 times daily50 mg/kg orally, divided 4 times daily
Empiric therapy for community-associated MRSA
  • TMP-SMX*1 to 2 DS tablets orally, twice daily‡8–12 mg/kg orally, divided twice daily
  • Doxycycline†100 mg orally, twice daily4 mg/kg orally, divided twice daily

  • DS—double strength, MRSA—methicillin-resistant Staphylococcus aureus, MSSA—methicillin-sensitive Staphylococcus aureus, TMP-SMX—trimethoprim-sulfamethoxazole.

  • ↵* Do not use TMP-SMX in infants younger than 1 mo old.

  • ↵† Avoid using doxycycline in children younger than 9 y of age.

  • ↵‡ Consider using 2 DS TMP-SMX tablets twice daily in individuals with body mass index of 40 kg/m2 or greater.6,7