Nonpurulent Cellulitis — don’t forget to give a beta lactam

Here’s a quick reminder for all my non-ID clinician friends out there. Cellulitis doesn’t always need vancomycin. If the patient has “nonpurulent” cellulitis (no purulent drainage or abscess) s/he should be managed with antibiotics with activity against beta-hemolytic streptococci and MSSA. The patient should usually go on a beta lactam such as cefazolin (we often use 1g q8 for a non-obese patient with a normal eGFR). Of course you have to think about MRSA risk factors as well, but vancomycin monotherapy is not sufficient for these patients.

IDSA guidelines for SSTI and subsequent discussion from Twitter:

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