CELLULITIS MANAGEMENT

POAC Clinical Eligibility Policy

PLEASE NOTE: This is NOT intended as a Clinical Guideline for management in Primary Care. Please see https://aucklandregion.healthpathways.org.nz for both adult and paediatric cellulitis pathways.

RATIONALE

POAC aligns its funding with the best practice recommendations contained within the Auckland Regional HealthPathways. These recommendations have been agreed by primary care clinicians and hospital specialists across the metro Auckland region. This includes Infectious Diseases, Medical Specialists and the regional Antimicrobial Stewardship Group.

POAC POLICY

ADULTS

POAC will fund IV Cephazolin for adult cellulitis (>/= 15 years) in the following patients:

Failed trial of oral antibiotics after 48 hours –please note, as per the HealthPathway, the initial redness can increase within the first 24 hours and is not necessarily a sign that oral antibiotics are failing. Patients should be given the patient information sheet on cellulitis management and asked to return in 48 hours if the redness is not settling, or at any time if they feel they are getting worse.
Limb cellulitis without significant systemic response or comorbidities but not suitable for oral antibiotics (refer to pathway for list of presentations not suitable for oral treatment).
When recommended by a specialist as initial therapy. Named specialist should be included in the POAC referral notes

CHILDREN

POAC funds IV Ceftriaxone for paediatric cellulitis (> 10 years and < 15 years) in the following patients:

Failed trial of oral antibiotics after 48 hours –please note, as per the pathway, the initial redness can increase within the first 24 hours and is not necessarily a sign that oral antibiotics are failing. The parents should be given the patient information sheet on cellulitis management and be asked to return in 48 hours if the redness is not settling, or at any time if they feel their child is getting worse.
Patient must be stable but not responding to oral treatment at 48 hours to be eligible for IV therapy in the community

General Notes

Assess the patient daily to determine if continued IV treatment is appropriate. Not all cases require 3 IV doses.
Use probenecid with cephazolin as directed by the pathway. Note the cautions and contraindications on the pathway, particularly in relation to use in renal impairment and pregnancy.
Antibiotics, either oral or intravenous, are not generally required for the management of abscesses and boils. Incision and drainage is the appropriate treatment. Request general surgery advice if a patient appears to need IV therapy post-drainage.
Recurrent cellulitis cases (>2 within 3 months) should be discussed with an Infectious Diseases consultant. They are available 24 hours a day, 7 days a week. Repeated courses of IV Cephazolin may not be effective in this patient group.
For paediatric cases >10 years old meeting the eligibility for IV antibiotics, use IV Ceftriaxone. POAC does not fund the use of cephazolin for cellulitis in children.
If insufficient improvement after 3 IV antibiotic doses, seek infectious disease advice. POAC does not fund fourth or subsequent doses unless approved by an infectious diseases specialist before administration. If the patient is suitable for IV therapy in the community but your clinic cannot provide the service, please generate a POAC referral and arrange treatment at any Urgent Care Clinic - see here for details