A 32-year-old woman with diabetes presents with a 3 days history of erythema, warmth, edema and pain of her forearm

Outpatient management with cephalexin or clindamycin and close follow-up

This patient can be managed as an outpatient for her uncomplicated cellulitis. Emerging antibiotic resistance must be considered in selecting the antibiotic, as well as the risk of community acquired methicillin-resistant staphylococcus aureus (CA-MRSA).

In this case, the absence of purulence points towards streptococcal species or simple staphylococus aureus. Simple, nonpurulent cellulitis can initially be treated with cephalexin or clindamycin; development of purulence would raise the concern for CA-MRSA.

Close followup, within 24-48 hours, is recommended for cellulitis, especially in the setting of diabetes, both as healing will be impaired and her glucose control might worsen. Osteolmyelitis is unlikely with this presentation.

Reference:

Palin DJ. Skin Infections (Chapter 129. In: Walls RM, Hockberger RS, Gausche-Hill M, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. 2018