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Cellulitis deterioration — GPhC CRA MCQ

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HardInfectionsCellulitis deteriorationGPhC CRA

A patient started oral flucloxacillin for lower-leg cellulitis 48 hours ago. Redness now extends 5 cm beyond the marked border, temperature is 39.1°C, pulse 116 beats/min and pain is markedly worse than the visible skin changes suggest. What is the best action?

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Correct answer: B — Arrange immediate hospital assessment for severe infection, sepsis or necrotising fasciitis

Some early extension can occur, but this patient has several danger signs: high fever, tachycardia, substantial spread after 48 hours and pain out of proportion. NICE advises reassessment for rapid or significant worsening and hospital referral when sepsis, necrotising fasciitis or another serious condition is suspected. Continuing unchanged treatment, independently altering the dose, adding topical antibiotic or treating the presentation as allergy would delay urgent assessment and source control.

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