A CASE PRESENTATION ON

CELLULITIS
BY
RUQIYA FATIMA (170715882002)

UNDER THE GUIDANCE OF

MD FAREEDULLAH SIR
DEPARTMENT OF PHARMACY PRACTICE
DECCAN SCHOOL OF PHARMACY
 CELLULITIS
• Cellulitis is a bacterial infection of the skin and tissues beneath the skin. Unlike 
impetigo, which is a very superficial skin infection, cellulitis is a bacterial skin
infection that also involves the skin's deeper layers: the dermis and subcutaneous
tissue.

Etiology:
The main bacteria responsible for cellulitis are Streptococcusand Staphylococcus ("
staph"), the same bacteria that can cause impetigo and other diseases. 

MRSA (methicillin-resistant Staph aureus) can also cause cellulitis.

Sometimes, other bacteria (for example, Hemophilus influenzae, Pneumococcus,
and Clostridiumspecies) may cause cellulitis as well.

sometimes cellulitis appears in areas where the skin has broken open, such as the
skin near ulcers or surgical wounds.

•.
• signs and symptoms:
– redness,
– pain and tenderness,swelling, and
– warmth of the affected area.
• Cellulitis can occur anywhere in the body. Cellulitis frequently affects the legs.
• Cellulitis is not contagious

• Complications :
• include spread of the infection into the bloodstream or to other body tissues.
• Cellulitis is treated with oral or intravenous antibiotics
• DIAGNOSIS:
• Although non-specific, nearly all patients have a raised white cell count and
elevated ESR or C-reactive protein. Normal results make a diagnosis of
cellulitis less likely.
• Culture of any local lesion is generally unrewarding – intradermal needle
aspiration yielding positive culture results in around 10% of cases and punch
biopsy in 20%. However where there is an open wound, drainage or an
obvious portal for microbial entry, a swab should be taken for culture.
 SUBJECTIVE DATA
• A 56 years old female patient was admitted in the general
medicine ward with chief complaints of fever,( shortness of
breath (grade 2) swelling of left limb and nausea.

• Past medical history:

• The patient is obese and also has a history of taking excessive
painkillers.(opoid analgesics like morphine)
• She is suffering from CAD and is on tab clopitab A(aspirin and
clopidogrel).
• The patient is conscious,coherent and coherent.
 OBJECTIVE DATA
• O/E The swelling on her leg is warmth tender and erythematous
• The following test were advised by the physician.
• ESR
• CRP
• ASO TITRE
• CBP
• ELECTROLYTES
• BLOOD UREA
• CREATININE
• HS TROPONIN
• D.DIMER
 ABNORMAL VALUES
TEST FINDINGS NORMAL VALUE
HS TROPONIN 51 UPTO 19
D-DIMER 531ng/ml Upto 200
ESR 1ST HOUR 60mm 0-5mm
ESR 2ND HOUR 105mm 5-10mm
ASO TITRE Positive -
RA FACTOR negative <10 IUL
WBC 12500CELLS/CUMM 7000-11000 CELLS/CUMM
 ASSESSMENT
• PROBLEM 1:Shortness of breath
• MEDICATION(s):nebuliser duolin and budecort every 4th hourly

• PROBEM 2:pain and fever

• MEDICATION(S): inj PCM(paracetamol) IV Stat

• PROBLEM 3:infection (cellulitis)

• MEDICATION(S): inj monocef(ceftriaxone) IV 1 gram.
• Inj.daleracin(clindamycin) 600mg /iv/TID

• PROBLEM 4:nausea
• MEDICATION(S):inj zofer(ondansetron) 4mg IV
•
• PROBLEM 5: ULCER PROPHYLAXIS
• MEDICATION(S): INJ PAN (pantoprazole)40mg IV BD

• PROBLEM 6:PEDAL EDEMA

• MEDICATION(S): TAB CHYMORAL FORTE (trypsin and chymotrypsin)TID

• PROBLEM 7: PAST HISTORY OF CAD

• MEDICATION(S): TAB CLOPITAB A (75/150) ( ASPIRIN AND CLOPIDOGREL)
BRAND GENERIC DOS FREQU ROUT DAY 1 DAY 2 DAY 3 DAY
NAME NAME TREATMENT CHART
E ENCY E 4
PAN Pantoprazole 40 OD IV    
mg
ZOFER Ondansetron 4mg OD IV -   

PCM Paracetamol 500 SOS IV   - -

mg

MONOC Ceftriaxone 1g BD IV    
EF
DUOLIN Salbutamol 4TH NASA   - -
BUDECO ,ipratropium HOURL L
RT br Y
/Budesonide
NS AND Normal 50m IV    
RL saline and l/hr
ringers
lactate

DALERIC clindamycin 600 TID IV    

IN mg
 DAY NOTES
• DAY 1
• VITALS:
• TEMP:102F BP 120/80 mmHg PR:83/min RR:20/min
• Chief complaints:SOB,fever,swelling and erythematous left limb
• Day 2
• VITALS:
• Temp 100F BP 110/80 mmHg PR:81/min RR:21/min
• Complaints :nausea
• Day3
• VITALS:
• Temp 98.4F BP 120/80 mmHg PR:75/min RR:19/min SOB subsided
• Fever subsided and patient is responding to treatment
• Day 4
• Patient is responding and all the vitals are stable and hence the patient can be
discharged.
 PLAN
• DISCHARGE MEDICATION:
• Tab DALERICIN(CLINDAMYCIN) 300 mg QDS
• Tab.PAN(PANTOPRAZOLE) 40mg OD (BEFORE BREAKFAST)
• TAB DOLO (PARACETAMOL) 650 MG SOS
• TAB MOTRIN(IBUPROFEN) 400MG SOS

• DURATION OF THERAPY : 7DAYS

• REVIEW IN OP DEPT AFTER 7 DAYS
 PATIENT COUNSELLING
• REGARDING DISEASE
Cellulitis is an infection of the skin and surrounding tissues.
It can happen on any area of the body but the leg is the
commonest site.
Most people make a complete recovery with a course of
antibiotics. Anyone can be affected but it is more common in
people who:
• Have poorly controlled diabetes.
• Have had an episode of cellulitis before
. • Have swollen legs or are overweight or obese.
. • Are prone to infections due to a poor immune system or
treatment with steroids.
• REGARDING MEDICATIONS:
• Take tab.pan atleast 30 min before food.
• Complete the entire course of antibiotics.
• Use liberal amount of moisturiser.
• Don’t miss the dose. Take the medicines on time
• Take your medicines with full glass of water.
 Regarding lifestyle modifications:
• Rest and elevation of the affected area.
• Regular antiseptic soaks
• Rarely visit to dermatologist (if needed).
• Painkillers such as pcm are useful to ease pain.
• Elevation of the leg means that your foot must be highe than your
hip
• Use a cushion on a sofa or chair.During the night place your foot on
a pillow in bed or place something firm under the foot of your
mattress.
• Use a moisturiser liberally.
• Use a soap substitute on the affected area of the skin to prevent it
from drying,reduce itching and help healing.
 Pharmacist interventions:
• budesonide + clopidogrel
• budesonide will increase the level or effect of clopidogrel by affecting hepatic/intestinal
enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the
metabolism of clopidogrel to its active metabolite. Monitor patients for potential
increase in antiplatelet effects when CYP3A4 inducers are used in combination with
clopidogrel
• The patient past habit of taking opoid analgesics might be the reason for development of
cellulitis hence a simpler nsaids like paracetamol OR celecoxib was suggested.

• Although there is evidence on long-term antibacterial prophylactic therapy prevents

recurrent cellulitis, it. Antibiotic prophylaxis for recurrent cellulitis is purely empirical and
optimal treatment and prophylaxis in these patients remains to be determined . Early patient
initiated treatment rather than long-term prophylaxis may be preferable .Small series have
reported benefit from prophylaxis with low dose Penicillin V or Erythromycin (both typically
250mg bd) or with intermittent IM depot Penicillin.
• The standard guidelines suggested the use of ceftriaxone as the first line drug and clindamycin
as the 2nd line drug but here both the drugs are given concomitantly.
THANK YOU