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Cellulitis — SCE Dermatology MCQ

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ModerateCutaneous InfectionCellulitisSCE Dermatology

A 70-year-old man with a prosthetic heart valve presents with an erythematous spreading cellulitis of his right lower leg. He is allergic to Penicillin (anaphylaxis). Which antibiotic is most appropriate?

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Correct answer: B — Oral Clarithromycin

For patients with true penicillin allergy (anaphylaxis), NICE and BAD guidelines recommend Clarithromycin as the oral alternative for non-severe cellulitis (or Erythromycin). Clindamycin is another alternative but carries a higher risk of Clostridioides difficile infection. Flucloxacillin and Co-amoxiclav contain the penicillin beta-lactam ring and are contraindicated in penicillin anaphylaxis. IV Vancomycin would be reserved for severe cellulitis or MRSA. The CREST cellulitis guidelines emphasise severity assessment and appropriate antibiotic selection based on allergy status.

Reference: NICE NG141 2019 Cellulitis; CREST 2005 Cellulitis Guidelines