- Home
- Urgent care
- Wounds, burns & skin
- Cellulitis
Cellulitis
Oral antibiotics at home or IV? Mark the edges and safety-net.
Typical consult⏱ 15–20 min
Investigations🔬 Usually none (bloods if systemically unwell)
Usual outcome💊 Flucloxacillin 5–7 days
0–5Red flags + history5–12Examine12–17Decide17–24Treat + explain24–30Safety-net + document
1Rule out first — red flags
| If you find… | …then |
|---|---|
| Systemically unwell, sepsis features | Admit / IV — sepsis pathway |
| Pain out of proportion, crepitus, rapid spread, skin necrosis | Necrotising fasciitis — surgical emergency |
| Periorbital / orbital: proptosis, painful eye movement, reduced vision | Orbital cellulitis — ophthalmology/ENT now |
| Bilateral red legs | Usually NOT cellulitis — venous eczema / lipodermatosclerosis |
| Diabetic foot infection | Diabetic foot team |
2Focused history
3Focused examination
4Decide — investigate only if it changes the plan
Severity (Eron-style)
- Class I: no systemic features, no uncontrolled comorbidity → oral antibiotics at home
- Class II: systemically unwell or comorbidity that may delay resolution → consider ambulatory IV / admission
- Class III–IV: significant systemic upset, sepsis, limb-threatening → admit
Most cellulitis in urgent care is class I.
| Investigation | Only if… |
|---|---|
| None for mild cellulitis | Clinical diagnosis |
| FBC, CRP, U&E, cultures | Only if systemically unwell or considering admission |
| Glucose | Recurrent infections or suspected diabetes |
5Treat & send home
Management & advice
- Mark the border; elevate the limb
- Treat tinea pedis if present (e.g. terbinafine cream)
- Skin may take longer than the course to look normal — that’s expected
- Review at 48 h if not improving (GP / ambulatory clinic)
Refer / follow-up
- Class II+ → ambulatory care / medical team
- Facial / periorbital → ophthalmology or ENT advice
℞
Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.
| Drug | Dose | Duration / notes |
|---|---|---|
| Flucloxacillin | 500 mg–1 g four times a day (on an empty stomach) | 5–7 days (NICE NG141) |
| Penicillin allergy: clarithromycin | 500 mg twice a day | 5–7 days |
| Penicillin allergy alternative: doxycycline | 200 mg on day 1, then 100 mg once a day | 5–7 days total (not in pregnancy) |
| Pregnancy + penicillin allergy: erythromycin | 500 mg four times a day | 5–7 days |
| Near the eyes or nose: co-amoxiclav | 500/125 mg three times a day | 7 days — consider specialist advice |
| Paracetamol | 1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk) | As needed |
6Safety-net
Say it like this
This is a skin infection called cellulitis. I’ve drawn around the edge so we can see if it spreads. Take the antibiotics regularly and keep the leg raised. The redness can take a week or two to fade completely, but it should stop spreading within 2 days. Come back if it goes past the line after 48 hours, or straight away if you feel feverish, faint or the pain becomes severe.
Come back / call 111 — or 999 if severe — if:
- Redness spreading beyond the pen line after 48 h on antibiotics
- Fever, shivers, feeling faint or confused
- Severe pain, blistering, dark or black skin
- Any eye swelling, pain or vision change (facial cellulitis)
7Patient leaflets — scan & go
Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.
8Document
Cellulitis — clinic note
A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.
URGENT CARE — CELLULITIS
PRESENTING COMPLAINT:
HISTORY
Onset, spread, pain, portal of entry (wound, bite, tinea between toes):
Fever, rigors, feeling unwell:
Previous cellulitis, lymphoedema:
PMH: diabetes, immunosuppression, PVD; allergies (penicillin — what reaction?):
Unilateral?:
RED FLAGS (record present / absent)
[ ] Systemically unwell, sepsis features
[ ] Pain out of proportion, crepitus, rapid spread, skin necrosis
[ ] Periorbital / orbital: proptosis, painful eye movement, reduced vision
[ ] Bilateral red legs
[ ] Diabetic foot infection
PMH:
DRUG HISTORY:
ALLERGIES:
SOCIAL (job / who is at home / driving):
OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 )
EXAMINATION
Obs (NEWS2):
Extent — mark the edge with pen, note date/time:
Warmth, tenderness, blistering, crepitus, necrosis:
Lymphangitis, lymph nodes:
Check between toes (tinea), wounds, ulcers:
DECISION RULE — Severity (Eron-style): result ______
INVESTIGATIONS: none required / None for mild cellulitis, FBC, CRP, U&E, cultures, Glucose — result:
IMPRESSION:
PLAN
Treatment / TTO (drug, dose, duration):
Advice given:
Leaflet given (QR / printed): Cellulitis, Antibiotics — when you need them
Follow-up / referral:
SAFETY-NETTING (told to return / call 111 / 999 if):
- Redness spreading beyond the pen line after 48 h on antibiotics
- Fever, shivers, feeling faint or confused
- Severe pain, blistering, dark or black skin
- Any eye swelling, pain or vision change (facial cellulitis)
Patient understands and agrees with the plan: Y / N
Seen by: Grade: Date/Time:
✓Guidelines
Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.
More wounds, burns & skin
Lacerations & wound careClose it right, check tetanus, and know which wounds aren’t yours.Minor burns & scaldsCool, cover, size it — and know when it goes to the burns unit.Human & animal bitesWho gets prophylaxis, rabies risk and the fight bite.Insect bites, stings & tick bitesBig local reactions vs infection vs anaphylaxis — and Lyme.