EMed

Cellulitis IV by CIT

Background

CIT Referral Criteria:

  • > 16 years old
  • Have an acceptable standard of living conditions. (The structure of the accommodation must be permanent in nature, have hot and cold running water and indoor toilet facilities)
  • Demonstrate an acceptable understanding of both verbal and written English, or evidence of an equally proficient supportive home translator available at all times
  • Have a contact number
  • Fit the CIT Inclusion criteria

OPAT Exclusion Criteria

  • Underlying Osteomyelitis, Necrotizing Fasciitis, Septic Joint or Abscess are not excluded from the DDx
  • Age <16 years
  • History of IVDU, renal impairment or diabetic related infections
  • Pregnancy
  • Renal impairment
  • Complex cellulitis (e.g. abscess/bursa/facial)
  • SBP <BP 100 mmHg
  • History of Clostridium difficile infection

Procedure

  • Admit to CDU under EM for initial labs and IV treatment
  • Start Cefazolin 2G IV OD and probenecid 1G PO OD
  • Assess for A) Thromboprophylaxis risk and B) CIT suitable
  • If improving, CIT available and no contraindications @ 24 hrs (x2 doses), Cefazolin 2g IV OD plus Probenecid 1g OD PO (Prescription 1)
  • If the patient has contraindications or intolerance, use Cefazolin 2g BD IV (Prescription 2)

Discharge checklist

  • Confirm adequate doses IVAB and probenecid tolerant
  • Patient advice - return CDU SOS
  • No work during IV therapy
  • Provide patient with pharmacy pack
  • Keep medical chart in CDU

Nursing staff checklist

  • Arrange medications to be dispensed (pharmacy)
  • Phone CIT on 087 9436971 with regard to the referral
  • Email referral and prescription to CIT
  • Inform GP of discharge arrangement by phone (or fax)
  • Arrange appointment for the patient to return

Notes on Cefazolin / Probenecid

  • If the patient is unable to tolerate the once daily regimen due to GI upset, then prescribe Cefazolin 2g twice daily iv without the probenecid
  • Check dosing (with pharmacist) in renal impairment
  • For penicillin allergic (OPAT/CIT only) patients, please contact micro. for advice on vancomycin dosing and monitoring

Probenecid contra-indicated with:

  • Methotrexate
  • Sodium phenylbutyrate
  • Ketorolac
  • Pyrazinamide
  • High dose aspirin
  • Dapsone
  • Heparin
  • Fosfomycin

Content by Dr Íomhar O' Sullivan 10/05/2019. Last review Dr ÍOS 10/06/21.