In the case of cellulitis, what is the appropriate treatment option for severe infections?

In the management of severe cellulitis, intravenous (IV) therapy is preferred. This is because severe infections often require rapid control and higher doses of antibiotics than can be achieved with oral formulations. The most appropriate treatment for severe cellulitis generally involves broad-spectrum coverage against common pathogens such as Streptococcus and Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA).

IV oxacillin or cefazolin provides effective coverage against methicillin-sensitive Staphylococcus aureus (MSSA) and Streptococcus species, which are typically responsible for infections of the skin and soft tissues. This choice ensures that the treatment reaches adequate serum levels quickly to address the acute infection.

While IV vancomycin is an option for suspected or confirmed MRSA infections, it is generally reserved for cases where there is a high suspicion of MRSA or when the infection is not responding to other treatments. In non-severe cases or when the infection is likely due to MSSA, simpler agents like oxacillin or cefazolin are more commonly used.

The use of oral dicloxacillin or oral cephalexin is appropriate for mild to moderate infections where patients can be treated on an outpatient basis but would not be sufficient for severe