Facial cellulitis (excluding pinna)
See separate guidelines for Periorbital cellulitis, Pinna cellulitis / perichondritis
Treat for 5 days (review iv daily), can extend to 7 days if slow to settle
See NICE guideline NG141 (revised 2019)
Preferred
flucloxacillin 1g iv qds (increase to 2g iv qds in obese patients)
For less severe cases or for oral follow on therapy, flucloxacillin 500mg - 1g po qds
Alternative
For penicillin allergy (non-severe)
cefazolin* 1g iv tds (increase to 2g iv tds in obese patients)
For less severe cases or for oral follow on therapy: cefalexin 1g po tds
*Caution: Prothrombin time, INR and APTT may increase on cefazolin treatment courses, please monitor. For more information see Cefazolin associated coagulation disorders
For penicillin allergy (severe) OR MRSA positive patients:
doxycycline 100mg po bd
OR
co-trimoxazole 960mg po bd (or iv if the oral route unavailable)