Recurrent Cellulitis Prophylaxis — SCE Dermatology MCQ

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EasyCutaneous InfectionRecurrent Cellulitis ProphylaxisSCE Dermatology

A 55-year-old man has recurrent cellulitis of his lower legs. He has had 4 episodes in the past year. What prophylactic strategy is recommended?

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Correct answer: E — Prophylactic low-dose Phenoxymethylpenicillin (Penicillin V 250 mg BD) for at least 12 months, alongside addressing predisposing factors (tinea pedis, lymphoedema, leg oedema)

NICE and CREST guidelines recommend prophylactic oral Penicillin V (250 mg BD or 500 mg BD) for patients with ≥2 episodes of cellulitis per year, continued for at least 12 months (and possibly longer if risk factors persist). The PATCH trial demonstrated that prophylactic Penicillin V reduced cellulitis recurrence by approximately 45% during the treatment period. For Penicillin-allergic patients, Erythromycin or Clarithromycin are alternatives. Equally important is addressing modifiable predisposing factors: treating tinea pedis (a common portal of entry for streptococci), managing lymphoedema with compression therapy, controlling leg oedema, emollient application to prevent skin fissuring, and treating dermatitis.

Reference: NICE; CREST Cellulitis Guidelines; PATCH Trial