Patient handout

Cellulitis & erysipelas

PRODUCTION

1. Your condition

This handout is for cellulitis & erysipelas. Your care team identified this based on: unilateral lower-extremity erythema, warmth, swelling, tenderness (idsa 2014 ssti stevens — classic presentation; nice 2019 ng141).

Other reasons your team may use this plan: sharply demarcated facial erythema (erysipelas) (nice 2019 ng141 — raised, well-defined border; idsa 2014 ssti stevens); leukocytosis + clinical skin signs (idsa 2014 ssti stevens — systemic inflammatory response).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
cephalexin	—	—	—	IDSA 2014 strong recommendation for non-purulent SSTI; covers strep + MSSA
dicloxacillin	—	—	—	IDSA 2014 alternative; flucloxacillin first-line in UK NICE NG141
clindamycin	—	—	—	IDSA 2014 SSTI Stevens — beta-lactam allergy backup; variable MRSA coverage (check local susceptibility)

Plan: Non-purulent cellulitis (outpatient PO)

3. When to call your provider

Contact your care team if any of the following happen:

No improvement / worsening at 48-72 h → ED for IV antibiotics + imaging (IDSA 2014 SSTI Stevens; NICE 2019 NG141)
Systemic features (fever, tachycardia) → ED (Eron 2003 class III-IV)
Necrotising features → emergent ED + surgery (IDSA 2014 SSTI Stevens)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Pain out of proportion, crepitus, bullae, rapid spread, systemic toxicity, "dishwater" drainage, OR LRINEC ≥6 (IDSA 2014 SSTI Stevens)(life-threatening)
qSOFA ≥2 OR SIRS positive + skin/soft tissue source (SSC 2021)
Failure to improve at 48-72 h after appropriate empiric therapy — extension of erythema border / new systemic toxicity / new abscess on US (IDSA 2014 SSTI Stevens)
Eron class 3 (significant systemic toxicity OR unstable comorbidity) or class 4 (sepsis / NF features) at initial assessment (Eron 2003; CREST 2005)
Neutropenic (ANC < 500) / transplant recipient / biologic agent / advanced HIV / chemotherapy host with cellulitis (IDSA 2014 SSTI Stevens; IDSA 2024 febrile neutropenia)

5. Follow-up

Treat tinea pedis / lymphedema / venous insufficiency (NICE 2019 NG141 — modifiable risk factors); PATCH II prophylactic penicillin V if ≥2 episodes/year (Thomas NEJM 2013 PATCH II); counsel on early re-presentation (NICE 2019 NG141)

6. Sources

Guideline: IDSA 2014 SSTI Guideline (Stevens et al, CID) + NICE NG141 (2019, updated 2024) + Eron 2003 classification + CREST 2005 cellulitis guidelines + Thomas NEJM 2013 PATCH II + Phoenix G NEJM 2023 STOP duration trial