Cellulitis, recurrent episodes of cellulitis

Always discuss cases with Micro/ID.

Guidelines are based upon NICE NG141

• Do not routinely offer antibiotic prophylaxis to prevent recurrent cellulitis or erysipelas. Give advice about seeking medical help if symptoms of cellulitis or erysipelas develop. 

• For adults who have had treatment in hospital, or under specialist advice, for at least 2 separate episodes of cellulitis or erysipelas in the previous 12 months, specialists may consider a trial of antibiotic prophylaxis. Involve the person in a shared decision by discussing and taking account of:
       • the severity and frequency of previous symptoms
       • the risk of developing complications
       • underlying conditions (such as oedema, diabetes or venous insufficiency) and their management
       • the risk of resistance with long-term antibiotic use
       • the person’s preference for antibiotic use.

• When choosing an antibiotic for prophylaxis take account of any previous microbiological results and previous antibiotic use.

• When antibiotic prophylaxis is given, give advice about:
       • possible adverse effects of long-term antibiotics
       • returning for review within 6 months
       • seeking medical help if symptoms of cellulitis or erysipelas recur.

• Review antibiotic prophylaxis for recurrent cellulitis or erysipelas at least every 6 months. The review should include:
       • assessing the success of prophylaxis
       • discussing continuing, stopping or changing prophylaxis (taking into account the person’s preferences for antibiotic use and the risk of antimicrobial resistance)
  

Stop or change the prophylactic antibiotic to an alternative if cellulitis or erysipelas recurs.