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Cellulitis in penicillin allergy — GPhC CRA MCQ

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HardInfection TherapeuticsCellulitis in penicillin allergyGPhC CRA

A 45-year-old has rapidly spreading cellulitis over the cheek extending towards the lower eyelid. He reports immediate anaphylaxis to penicillin and is systemically well. Which initial antimicrobial pathway best follows NICE guidance?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Clarithromycin plus metronidazole with same-day clinical assessment

Cellulitis near the eyes or nose has a higher risk of serious complications and follows a distinct antibiotic pathway. Co-amoxiclav is usual first choice, but immediate penicillin anaphylaxis removes that option. NICE lists clarithromycin with metronidazole as the alternative first-choice regimen and advises seeking local microbiology advice when needed. Rapid progression towards the lower eyelid also warrants same-day clinical assessment.

Reference: NICE NG141, Cellulitis and erysipelas—antimicrobial prescribing: https://www.nice.org.uk/guidance/ng141/chapter/Recommendations