How do you decide which patients with recurrent lower-extremity cellulitis should receive long-term antibiotic prophylaxis?

When I suspect recurrent streptococcal cellulitis, one of the most important things I can offer is to emphasize edema management and help the patient find a skilled lymphedema specialist.

Webb et al. showed a striking benefit from compression therapy: cellulitis recurred in 15% of patients receiving ...

It's not very scientific when I do decide to do it; generally, things I take into consideration include ADLs (activities of daily living), hospitalizations (specifically with concurrent bacteremia), and dermatologic conditions that may be contributing. I obviously push a lot for management of edema,...

When thinking about antibiotic prophylaxis or suppression in any setting (recurrent cellulitis, recurrent UTIs), I usually look at the frequency with which the patient is on antibiotics for the recurring issue already to help determine if chronic therapy makes sense. For example, if a patient is hav...

It is not very often that I consider long-term prophylaxis. The times I have is in patients who have had severe recurrent streptococcal cellulitis, typically lower extremity. In these cases, the patients had systemic symptoms associated with the cellulitis that warranted prevention.

I have never prescribed antibiotic "prophylaxis" for recurrent lower extremity cellulitis during my 50 years in practice. Many of the referrals we receive for "recurrent cellulitis" actually have chronic lymphedema, and their "cellulitis" resolves with elevation alone. The patients I have seen with ...