Cellulitis/Erysipelas Drug Summary

Last updated: 15 March 2026
Reviewed by

Aminoglycosides

Drug Dosage Remarks
Amikacin 15 mg/kg/day IM/IV divided 8-12 hourly x 7-10 days
Max dose: 1.5 g/day 		Adverse Reactions
  • Ototoxic effects (irreversible hearing loss, dizziness, vertigo); Renal effects (reversible nephrotoxicity, acute renal failure has been reported usually when other nephrotoxic drugs have also been administered); Other effects (neuromuscular blockade resulting in respiratory depression and muscular paralysis)
Special Instructions
  • Use with caution in patients with conditions associated with muscle weakness (eg myasthenia gravis, Parkinson’s disease), patients with pre-existing renal dysfunction, vestibular or cochlear impairment
  • Ototoxicity and nephrotoxicity are most likely in patients who are geriatric, dehydrated, with renal impairment, receiving high doses or for long periods and receiving or have received other ototoxic/nephrotoxic drugs
    • Consider monitoring serum concentrations and/or peak serum concentrations/minimum inhibitory concentration ratio in patients at risk for ototoxicity or nephrotoxicity
Gentamicin 3-5 mg/kg/day IM/IV
divided 8-12 hourly

Antibacterial Combination

Drug Dosage Remarks
Co-trimoxazole
(Sulfamethoxazole
[SMX] and 
Trimethoprim
[TM]) 		800 mg SMX/160 mg TM PO 12 hourly Adverse Reactions
  • GI effects (nausea/vomiting, anorexia, diarrhea); Dermatologic effect (photosensitivity); Hypersensitivity reactions (rash, pruritus, Stevens-Johnson syndrome [SJS]); GU effect (crystallization in the urine)
Special Instruction
  • Maintain adequate fluid intake
  • Contraindicated in patients allergic to sulphonamides
  • Use with extreme caution or not at all in patients with hematological disorders especially megaloblastic anemia due to Folic acid deficiency
  • Use with caution in patients with renal impairment or severe hepatic dysfunction and in patients with folate deficiency (may consider administration of Folinic acid)

Cephalosporins

Drug Dosage Remarks
First Generation Adverse Reactions
  • Hypersensitivity reactions (urticaria, pruritus, rash, anaphylaxis); GI effects (diarrhea, nausea/vomiting, increased LFTs); CNS effects (headache, dizziness; high doses associated with encephalopathy and convulsions); Local effects (phlebitis, pain, inflammation); Other effect (candidal infection)
  • Prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (PTT) and/or hypoprothrombinemia (with or without bleeding) have been reported and occur most frequently with N-methylthiotetrazole side chain-containing cephalosporins
Special Instructions
  • May be taken with food to decrease gastric distress
  • Use with caution in patients with non-severe hypersensitivity reactions to cephalosporins, penicillins or other drugs and renal impairment
Cefaclor 250-500 mg PO 8 hourly
Cefadroxil 1 g PO 24 hourly or divided 12 hourly
Cefalexin (Cephalexin) 250 mg PO 6 hourly or 500 mg PO 12 hourly
Cefazolin 1 g IV/IM 6 hourly
Cefradine (Cephradine) 1-2 g/day divided 6-12 hourly
or 2-4 g/day IV/IM divided 6 hourly
Second Generation
Cefmetazole 500 mg-1 g IV 12 hourly
Cefotiam 200-400 mg PO 12 hourly
Cefoxitin 1-2 g IV/IM 6-8 hourly
Cefprozil 250 mg PO 12 hourly or 500 mg PO 12-24 hourly
Cefuroxime 250-500 mg PO 12 hourly or 750 mg-1.5 g IV/IM 6-8 hourly
Third Generation
Cefdinir 100 mg PO 8 hourly
Cefditoren pivoxil 200 mg PO 12 hourly x 10 days
Cefoperazone 2-4 g/day IV/IM divided hourly
Cefotaxime 1-2 g IV/IM 12 hourly
Ceftazidime 1-2 g IV/IM 8 hourly
Ceftriaxone 1-2 g IV/IM 12-24 hourly
Fourth Generation
Cefepime 1-2 g IV/IM 12 hourly
Cefpirome 1 g IV/IM 12 hourly
Fifth Generation
Ceftaroline fosamil Minimum inhibitory concentration (MIC) <2 mg/L: 600 mg IV infusion over 5-60 minutes 12 hourly
MIC 2-4 mg/L: 600 mg IV infusion over 120 minutes 8 hourly
Cephalosporin with Beta-lactamase Inhibitor
Cefoperazone/sulbactam 2-4 g IV/IM 12 hourly
May be increased to 8 g/day IV 12 hourly for severe infections

Macrolides

Drug Dosage Remarks
Azithromycin 500 mg PO 24 hourly x 3 days or
500 mg PO 24 hourly x 1 day followed
by 250 mg PO 24 hourly x 4 days 		Adverse Reactions
  • Ototoxic effects (irreversible hearing loss, dizziness, vertigo); Renal effects (reversible nephrotoxicity; acute renal failure has been reported usually when other nephrotoxic drugs have also been administered); Other effects (neuromuscular blockade resulting in respiratory depression and muscular paralysis)
Special Instructions
  • Use with caution in patients with conditions associated with muscle weakness (eg myasthenia gravis, Parkinson’s disease), patients with pre-existing renal dysfunction, vestibular or cochlear impairment
  • Ototoxicity and nephrotoxicity are most likely in patients who are geriatric, dehydrated, with renal impairment, receiving high doses or for long periods and receiving or have received other ototoxic/nephrotoxic drugs
    • Consider monitoring serum concentrations and/or peak serum concentrations/MIC ratio in patients at risk for ototoxicity or nephrotoxicity
Clarithromycin 250-500 mg PO 12 hourly
Extended-release:
500 mg-1 g PO 24 hourly
or
500 mg IV 12 hourly x 2-5 days, then
switch to oral therapy
Erythromycin 500 mg PO 6 hourly or 25-50 mg/kg/day IV in divided doses
Max dose: 4 g/day
Roxithromycin 150 mg PO 12 hourly or
300 mg PO 24 hourly x 5-10 days

Other Antibiotics

Drug Dosage Remarks
Clindamycin 300-450 mg PO 6 hourly or 600 mg IV/IM 8 hourly or 900 mg IV 8 hourly Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, abdominal pain, unpleasant metallic taste, possible antibiotic-associated pseudomembranous colitis, abnormal LFTs); Hematologic effects (transient leukopenia, agranulocytosis, eosinophilia, thrombocytopenia); Other effects (erythema multiforme, polyarthritis)
Special Instructions
  • Contraindicated in patients with diarrhea
  • Use with caution in patients with gastrointestinal disease, hepatic or renal impairment, a history of colitis or atopy
  • Periodic liver and kidney function tests and CBC should be done during prolonged therapy
Daptomycin 4 mg/kg IV 24 hourly Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, constipation); Hematologic effect (anemia); Dermatologic effect (rash)
Special Instructions
  • Use with caution in patients with renal impairment
  • Monitor creatine phosphokinase levels once weekly or more frequently in high-risk patients
  • Monitor for signs and symptoms of neuropathy
Lincomycin 500 mg PO 8 hourly or 600 mg IM 12-24 hourly or 600-1,000 mg IV 8-12 hourly Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, esophagitis, abdominal discomfort); Dermatologic effects (pruritus, rash, urticaria)
Special Instructions
  • Use with caution in patients with history of GI disease, asthma or significant allergies, impaired hepatic or renal function
  • Discontinue if diarrhea occurs
Linezolid 400-600 mg PO/IV 12 hourly Adverse Reactions
  • GI effects (diarrhea, nausea); CNS effect (headache)
  • Less common: GI effects (oral moniliasis, dyspepsia, localized abdominal pain, tongue discoloration); Other effects (hypertension, pruritus, thrombocytopenia)
Special Instructions
  • Avoid intake of food and beverage with high tyramine content (eg cheese) and adrenergic and serotonergic agents
Metronidazole Pelvic cellulitis:
1 g vaginal suppository 8 hourly
Treatment of ≥3 days: 1 g vaginal suppository 12 hourly 		Adverse Reactions
  • GI effects (epigastric pain, nausea/vomiting, diarrhea, oral mucositis, taste disorders, anorexia, reversible pancreatitis, tongue discoloration, furry tongue); CV effects (angioedema, anaphylactic shock); CNS effects (peripheral sensory neuropathy, headache, convulsions, dizziness, encephalopathy, subacute cerebellar syndrome, aseptic meningitis); Psychologic effects (confusion, hallucinations, depressed mood); Ophthalmologic effects (transient vision disorders, diplopia, myopia, blurred vision, decreased visual acuity, changes in color vision, optic neuropathy/neuritis); Hematologic effects (agranulocytosis, neutropenia, thrombocytopenia); Metabolic effects (increased AST, ALT, and alkaline phosphatase, cholestatic or mixed hepatitis, hepatocellular liver injury, liver failure); Dermatologic effects (rash, pruritus, flushing, urticaria, pustular eruptions, erythema multiforme); Other effect (fever)
Special Instructions
  • Use with caution in patients at risk for CNS disease, hepatic dysfunction, alcoholism
  • Perform hematologic tests during prolonged administration
Sodium fusidate 250 mg PO 12 hourly Adverse Reactions
  • GI effects (dyspepsia, nausea/vomiting); Other effects (reversible jaundice and increase of transaminases)
Special Instructions
  • Use with caution in patients with liver dysfunction
Teicoplanin Initial dose: 6 mg/kg IM/IV bolus over 3-5 minutes or infused over 30 minutes 12 hourly x 3 doses
Maintenance dose:
6 mg/kg IM/IV 24 hourly 		Adverse Reactions
  • Hypersensitivity effects (fever, chills, skin rash, pruritus, occasionally anaphylaxis, bronchospasm, SJS); GI effect (GI disturbances); CNS effects (dizziness, headache); Hematologic and hepatic effects
Special Instructions
  • Use with caution in patients with pre-existing renal dysfunction
  • Monitor renal and auditory function if on prolonged therapy
  • Periodic monitoring of CBC and LFTs are advised
Vancomycin 500 mg IV 6 hourly 
or 
1 g IV 12 hourly 		Adverse Reactions
  • Less common: Change in the frequency of urination or amount of urine, chills, coughing, difficulty of breathing, drowsiness, fever, increased thirst, loss of appetite, nausea/vomiting, sore throat, weakness
  • Rare: Abdominal tenderness, abnormal bleeding or bruising, large blisters on arms, legs, hands, feet or upper body, loss of hearing, ringing, buzzing or feeling of fullness in the ears, severe abdominal or stomach cramps and pain, bloody diarrhea
Special Instructions
  • Watch out for the development of red man syndrome: Chills or fever, fainting, fast heartbeat, hives, itching, low blood pressure, nausea or vomiting, rash or redness of the face, base of neck, upper body, back and arms
  • Use with caution in patients with renal and hearing impairment

Other Beta-lactams

Drug Dosage Remarks
Carbapenems
Imipenem/cilastatin 500 mg IV 6 hourly
or 1 g IV 8 hourly 		Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, antibiotic-associated diarrhea/colitis, tongue/tooth discoloration, altered taste); Hypersensitivity effects (rash, anaphylaxis); CNS effects (mental disturbances, confusion); Other effect (candidal infections)
  • Imipenem/cilastatin: Seizures/convulsions have been reported especially in patients with history of CNS lesions and renal dysfunction
Special Instructions
  • Use with caution in patients allergic to penicillins, cephalosporins or other β-lactams, with renal impairment and CNS disorders (eg epilepsy)
Meropenem 500-1,000 mg IV 8 hourly
Monobactam
Aztreonam 1-2 g IV 8-12 hourly Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, pseudomembranous colitis, GI bleeding); Hepatic effects (jaundice, hepatitis, increased liver enzymes); Other effects (PT and PTT prolongation, local reactions at infusion site, skin rash, pruritus)
Special Instructions
  • Use with caution in patients with history of β-lactam hypersensitivity, renal and hepatic impairment

Penicillins

Drug Dosage Remarks
Benzylpenicillin (Penicillin G, Penicillin G Na, Penicillin G K) 0.6-2.4 g IM/IV/day divided 6-12 hourly Adverse Reactions
  • Hypersensitivity effects (rash, urticaria, pruritus, anaphylaxis); GI effects (diarrhea, nausea/vomiting); Other effect (candidal infections)
  • High doses may be associated with CNS effects (encephalopathy, convulsions)
Special Instructions
  • Avoid in patients with Penicillin allergy
  • Use with caution in patients with renal impairment
Phenoxymethylpenicillin
(Penicillin V) 		250-500 mg PO 4-6 hourly
Aminopenicillins with or without Beta-lactamase Inhibitors
Amoxicillin (Amoxycillin) 250-500 mg PO 8 hourly or
500 mg PO 12 hourly
Amoxicillin/clavulanic acid
(Co-amoxiclav, Amoxicillin/clavulanate) 		375 mg PO 8 hourly or
625 mg PO 8-12 hourly or
1 g PO 8-12 hourly or
1.2 g IV 6-8 hourly
Ampicillin/sulbactam
(Sultamicillin: Pro-drug of
Ampicillin/sulbactam) 		1.5-3 g IV 6 hourly
Sultamicillin tosylate (Sultamicillin
tosilate) 		375-750 mg PO 12 hourly
Antipseudomonal Penicillins with or without Beta-lactamase
Inhibitors
Piperacillin 3-4 g IV/IM 4-6 hourly
Max dose: 24 g/day
Piperacillin/tazobactam 2.25-4.5 g IV/IM 6-8 hourly
Ticarcillin 200-300 mg/kg/day IV divided 4-6 hourly
Ticarcillin/clavulanic acid
(Ticarcillin/clavulanate) 		3.2 g IV 6-8 hourly
Antistaphylococcal Penicillins
Cloxacillin 250-500 mg PO 6 hourly
Max dose: 6 g/day or
250-500 mg IM/IV 4-6 hourly
Dicloxacillin 125-500 mg PO 6 hourly
Flucloxacillin 250-500 mg PO 6 hourly or
250-500 mg IM 6 hourly or
250 mg-1 g IV 6 hourly
Oxacillin 500 mg-1 g PO 6 hourly
Max dose: 12 g/day or
250 mg-2 g IV/IM 4-6 hourly

Quinolones

Drug Dosage Remarks
Ciprofloxacin 500-750 mg PO 12 hourly or
400 mg IV 8-12 hourly infused over 30-60 minutes		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain, dyspepsia, diarrhea); CNS effects (headache, dizziness, sleep disorders, restlessness, drowsiness); Dermatologic effects (rash, pruritus, photosensitivity); Hypersensitivity effects (rash, SJS)
  • Some quinolones have the potential to prolong the QT interval
Special Instructions
  • Administer at least 2 hours before or 3 hours after Al- or Mg-containing antacids, dietary supplements containing Zn or Fe or buffered Didanosine preparations
  • Avoid exposure to strong sunlight or tanning beds
  • Use with caution in patients with epilepsy or history of CNS disorders, in patients with impaired renal or hepatic function and in those with glucose-6-phosphate dehydrogenase (G6PD) deficiency
Delafloxacin 450 mg PO 12 hourly or
300 mg IV infusion over 60 minutes 12 hourly
Levofloxacin 500-750 mg PO/IV 24 hourly
Moxifloxacin 400 mg PO/IV 24 hourly
Ofloxacin 400 mg PO/IV 12 hourly

Tetracyclines

Drug Dosage Remarks
Doxycycline 100 mg PO 12 hourly or
200 mg PO 24 hourly x 1 day
Followed by 50 mg PO 12 hourly or
100 mg PO 24 hourly 		Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, dry mouth, antibiotic-associated diarrhea/colitis, dysphagia, esophageal ulceration has occurred when taken with an insufficient amount of liquid); CV effects (changes in heart rate, vasodilation); Dermatologic effects (photosensitivity, rash, pruritus); Other effects (candidal infections, discoloration of teeth, interference with bone growth in young infants/pregnant women)
Special Instructions
  • Avoid long exposure to sunlight or tanning beds; take with plenty of fluid while sitting or standing and well before retiring to bed
  • Avoid in patients with systemic lupus erythematosus (SLE) and pregnant women
  • Use with caution in renal or hepatic impairment
Minocycline 100-200 mg PO 24 hourly x 1 day
Followed by 100 mg PO 12 hourly
Tigecycline 100 mg IV 24 hourly as loading dose
Followed by 50 mg IV 12 hourly

Topical Antibiotic

Drug Dosage Remarks
Mupirocin Apply to affected area 8-12 hourly x 10 days Adverse Reactions
  • Most preparations are well-tolerated
  • Discomfort or pruritus localized to area of application
Special Instructions
  • Contraindicated in patients with known hypersensitivity
  • Use with caution in patients with moderate or severe renal impairment

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

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