In addition, there are differences in definitions for cellulitis. We will review what has been MK5108 published since the 2005 Infectious Diseases Society of America (IDSA) guideline. The 2013 Sanford guide recommends only empirical streptococcal coverage for cellulitis of the extremities in
non-diabetics . MRSA coverage OSI-027 chemical structure is recommended only for severe disease in diabetics and facial cellulitis. The Johns Hopkins ABX Guide generally concurs with the Sanford guide in emphasizing anti-streptococcal coverage but recommends MRSA coverage for hospitalized patients (intravenous clindamycin, vancomycin, linezolid, daptomycin, ceftaroline, or telavancin) regardless of the presence of diabetes . The IDSA guideline for erysipelas or cellulitis recommends “dicloxacillin, cephalexin,
clindamycin, or erythromycin, unless streptococci or staphylococci resistant to these agents are common in the community” . The IDSA guidelines were published in 2005 and an update will not be ready until late 2013 . The more recent (published 2011) IDSA guidelines for MRSA recommend empirical (MRSA) coverage only for purulent cellulitis . In 2007, the Centers for Disease Control published similar guidelines for skin and soft-tissue infections BTSA1 manufacturer that included endorsement by IDSA and the American Medical Association . Empirical MRSA coverage for non-purulent cellulitis is not recommended unless a therapeutic failure has occurred. These guidelines also suggest that empirical (MRSA) coverage for complicated skin and soft-tissue infections Protein kinase N1 be considered in hospitalized patients. MRSA has become common in the United States and is more prevalent than methicillin-sensitive Staphylococcus aureus (MSSA) in many communities . Many, if not most physicians, routinely cover for MRSA using trimethoprim/sulfamethoxazole (TMP/SMX), clindamycin, doxycycline or fluoroquinolones in patients with cellulitis . Some authors advocate empirical coverage of cellulitis when the skin
is intact . Others suggest that empirical therapy for CAMRSA be limited to seriously ill patients or those who have failed initial empirical therapy . Still others recommend such coverage when the community prevalence is high, such as greater than 10–15% [7, 11]. Is that appropriate in 2013? Should diabetics with cellulitis always receive empirical coverage for MRSA? Methods PubMed was searched for the terms “cellulitis,” “MRSA,” “skin and soft tissue infection,” “community acquired staphylococcus” and combinations of these terms during the month of May, 2013. The results were narrowed by omitting articles not in English and those with terms including ophthalmic, systemic, case studies, hospitalized, and purulent. Additional articles were added in October as a result of reviewer’s comments.