Cellulitis

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Click here to access the Primary-Healthcare-Chapter-5-Skin-Conditions-with-Supporting-NEMLC-Report-2020-4-Review-Version-2.0-November-2025

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Description

General Measures

Medicine Treatment

Referral

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ICD 10 code: L03.0-3/L03.8-9

DESCRIPTION

• A diffuse, spreading, acute infection within skin and soft tissues, commonly caused by streptococci
• Characterised by:
  • Oedema 
  • Redness
  • Increased local temperature
  • No suppuration
• Frequently associated with lymphangitis and regional lymph node involvement
• Commonly occurs on the lower legs, but may occur elsewhere
• May follow minor trauma
• May present as an acute fulminant or chronic condition
• May occur with systemic manifestations of infection:
  • Fever
  • Tachycardia
  • Hypotension
  • Chills 
  • Delirium/ altered mental state

GENERAL MEASURES

• Elevate the affected limb to reduce swelling and discomfort

MEDICINE TREATMENT

Children ≤ 7 years of age

• Cefalexin, oral, 25 mg/kg/dose 12 hourly for 5 days. See: dosing table

OR

• Flucloxacillin, oral, 12–25mg/kg/dose 6 hourly for 5 days. See: dosing table

Children > 7 years of age and adults

• Cefalexin, oral, 500 mg 6 hourly for 5 days

OR

• Flucloxacillin, oral, 500 mg 6 hourly for 5 days

LoE:IVb⁷

For severe penicillin allergy: 
ICD 10 code: Z88.0

Children

• Macrolide, e.g.:
• Azithromycin, oral, 10 mg/kg/dose daily for 3 days. See: dosing table

Adults

• Macrolide, e.g.:
• Azithromycin, oral, 500 mg daily for 3 days

Severe cellulitis:

• Refer for parenteral antibiotics

REFERRAL

Urgent

• Children who have significant pain, swelling or loss of function (to exclude osteomyelitis)
• Haemorrhagic bullae, gas in the tissues or gangrene
• Extensive cellulitis
• Recurrent cellulitis associated with underlying conditions, e.g. lymphoedema
• Cellulitis with systemic manifestations, e.g. confusion, hypotension
• Poorly controlled diabetic patients
• Involvement of the hand, face and scalp

Non-urgent

• Inadequate response to initial antibiotic treatment

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024

Chapter 5: Skin Conditions_5.4.3 Cellulitis