Diagnosis and management of lower limb cellulitis

What you need to knowOlder patients (particularly those over 65) are at increased risk for cellulitis.Lower limb cellulitis is almost always unilateral; bilateral involvement should prompt consideration of alternative diagnoses.Cellulitis is mainly a clinical diagnosis; routine blood tests or cultures are not required in uncomplicated cellulitis.Oral antibiotics (penicillins or first generation cephalosporins) prescribed for five to seven days are the first line treatment for uncomplicated cellulitis and are non-inferior to intravenous antibiotics.Reassess patients within 48-72 hours of starting antibiotics.A 71 year old woman presents to the emergency department with 48 hours of pain, erythema, and swelling of the right lower leg. She appears comfortable, is alert and oriented, and can walk independently. Her temperature is 38.3ºC and her other vital signs are normal. She has a history of type 2 diabetes mellitus, hypertension, and venous stasis dermatitis. Her medications include metformin and ramipril. She has no allergies.Cellulitis is a bacterial…