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NICE publish guidelines for antimicrobial prescribing in cellulitis and erysipelas

For Cellulitis

The National Institute for Health and Care Excellence (NICE) have published a guideline on antimicrobial prescribing in the treatment of cellulitis and erysipelas.

Cellulitis is a skin infection, mostly of the hands, feet and legs, that's treated with antibiotics. It can be serious if it's not treated quickly.

Erysipelas is a superficial form of cellulitis typically caused by streptococci bacteria. Erysipelas causes a shiny, painful, red, raised patch on the skin. The edges have distinct borders and do not blend into the nearby normal skin. The patch feels warm and firm to the touch. It occurs most frequently on the legs and face. People often have a high fever, chills, and a general feeling of illness (malaise).

The guideline recommendations cover:
  • Managing cellulitis and erysipelas
  • Choice of antibiotic
  • Preventing recurrent cellulitis or erysipelas
  • Choice of antibiotic prophylaxis
Cellulitis and erysipelas are skin infections that can be serious. Both infections usually develop when bacteria enter the body through a cut or sore on the skin. Symptoms include redness and swelling that may feel hot and painful and can spread quickly. These infections usually affect the legs but can occur anywhere on the body.

Using antibiotics when they are not needed means they may not work as well in the future. This is a serious health risk so NICE has written advice about when to offer antibiotics for some common conditions.

Because cellulitis and erysipelas are bacterial infections and can be serious, you should be offered antibiotics.

Your doctor should explain that antibiotics can cause side effects, such as diarrhoea and nausea (feeling sick).

Your symptoms should start to improve within a few days of starting antibiotics. You should see your doctor if you don’t start to feel better 2 to 3 days after you start antibiotics, if your symptoms suddenly get worse at any time (including if the redness or swelling continue to spread) or you feel very unwell. They may refer you to hospital if you have signs of a serious illness.

Your skin may take some time to return to normal after you have finished taking the course of antibiotics.

NHS website for cellulitis
Merck Manual for erysipelas
Contains public sector information licensed under the Open Government Licence v3.0.
Accessed 28/09/19
Links available in External Resources

© NICE [2019]

Cellulitis and erysipelas: antimicrobial prescribing. NICE guideline [NG141]. Published date: September 2019
Available from: See Link below. All rights reserved. Subject to Notice of rights
NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

The information provided by NICE was accurate at the time this article was issued.

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