Management of impetigo and cellulitis: Simple considerations for promoting appropriate antibiotic use in skin infections

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Table 1.

Empiric antibiotic selection for nonpurulent and purulent cellulitis

ANTIBIOTIC	USUAL ADULT DOSE	PEDIATRIC DOSE
Nonpurulent cellulitis
Empiric therapy for group A streptococcus
• Cephalexin	500 mg orally, 4 times daily	50–100 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
• Cephalexin	500 mg orally, 4 times daily	50–100 mg/kg orally, divided 4 times daily
• Cloxacillin	500 mg orally, 4 times daily	50 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 daily	4 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