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Chief Complaint

“My leg just keeps getting more red and painful.”

History of Present Illness

Mrs. Davenport is a 59-year-old female with type 2 DM and CAD. She presents today to her primary care physician as a follow up from starting cephalexin three days ago for lower extremity cellulitis. Today she is febrile to 101.2 and noted to have worsening erythema and pain to the left lower extremity. She confirms adherence to the antibiotics.

Student Work-Up

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Missing Information?


Patient Database

Drug Therapy Problems

Care Plan (by Problem)


  1. What are the two most common pathogens to be concerned about causing the infection for Mrs. Davenport?

    Hint: Consider the bacteria that reside on the location of the infection. When there is a break to the skin the bacteria or normal floral will have access. See Cellulitis and Erysipelas in PPP

  2. What is the significance of determining if the cellulitis is purulent or non-purulent?

    Hint: When considering antibiotic therapy, it is essential to determine potential pathogens. See Table 76-2 in PPP

  3. Would this patient be most appropriately treated as outpatient or inpatient? Please explain the considerations.

    Hint: See Cellulitis and Erysipelas in PPP

  4. Describe an appropriate antibiotic therapy regimen for this infection?

    Hint: See Table 76-3 in PPP

  5. Antibiotic therapy was initiated based on your recommendation. What indicators would determine when it is appropriate to change from IV to oral regimen.

    Hint: See Cellulitis and Erysipelas in PPP


After treatment is completed, what are recommendations that we can give to Mrs. Davenport to reduce the risk of recurrence of the cellulitis?

Hint: See Cellulitis and Erysipelas in PPP


Global Perspective

Globally in the last ten years there has been an increase incidence of cellulitis by 22 percent. In the United States, it is estimated at 14.5 million cases accounting for $3.7 billion in ambulatory care cost. Globally the pathogens are similar with beta hemolytic Streptococcus and Staphylococcus aureus being the most common; however, the resistance ratees of S. aureus have been noted to be different between continents. The highest rate of resistance S. aureus is North America (35.9%), followed by Latin America (29.4%) and Europe (22.8%).

Key References

1. +
Practice Guidelines for the diagnosis and management of skin and soft tissue infections: 2014 Update by the Infectious Disease Society of America. Clinical Infectious Diseases. 2014: 59(2): e10–e52,  [PubMed: 24973422]

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