What are the recommended antibiotic regimens for treating uncomplicated cellulitis in adults?

Recommended antibiotic regimens for treating uncomplicated cellulitis in adult patients:

• First-line treatment is flucloxacillin 500 to 1000 mg four times daily for 5–7 days.
• If flucloxacillin is unsuitable or the patient has a penicillin allergy, prescribe one of the following alternatives for 5–7 days: clarithromycin 500 mg twice daily, doxycycline 200 mg on the first day then 100 mg once daily, or erythromycin 500 mg four times daily (preferred in pregnancy).
• For infections near the eyes or nose, seek specialist advice and consider co-amoxiclav 500/125 mg three times daily for 7 days. If co-amoxiclav is unsuitable or there is penicillin allergy, prescribe clarithromycin 500 mg twice daily plus metronidazole 400 mg three times daily for 7 days.
• For adults with known lymphoedema who develop cellulitis but do not require admission or referral, prescribe flucloxacillin 500-1000 mg four times daily for 14 days. If not tolerated, use amoxicillin 500 mg three times daily for 14 days, or if penicillin allergic, clarithromycin 500 mg twice daily for 14 days.

Advise patients to seek medical help if symptoms worsen rapidly or do not improve within 2–3 days, and provide supportive care advice such as analgesia and elevation of the affected limb where applicable.

These recommendations are based on the NICE guideline on cellulitis and erysipelas antimicrobial prescribing and related UK expert guidance.