# Facial cellulitis / erysipelas (urgent referral pathway) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: IDSA Skin and Soft Tissue Infection Guidelines 2014 · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) · Cellulitis - StatPearls - NCBI Bookshelf (NBK549770) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) - Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), p. 246, ceftriaxone monograph, Prescribing Limits: "Pediatric Patients Endocarditis or meningitis: Maximum 4 g daily. Most other infections: Maximum 2 g daily." ## Treatment metadata - Ceftriaxone — 1000 mg — injection - Amoxicillin + Clavulanic acid — 875 mg — oral.solid - Cephalexin — 500 mg — oral.solid - Cefazolin — injection - Clindamycin — 300 mg — oral.solid - Sulphamethoxazole + Trimethoprim — oral.solid ## Complete treatment card ```text FACIAL CELLULITIS / ERYSIPELAS (URGENT REFERRAL PATHWAY) Sources: IDSA Skin and Soft Tissue Infection Guidelines 2014 · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) · Cellulitis - StatPearls - NCBI Bookshelf (NBK549770) Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Relevant history includes recent travel, trauma, intravenous drug use, or an insect or animal bite to the area [animal bite] - Fever, malaise, and fatigue can accompany more severe cases, reflecting systemic involvement [fatigue · fever · malaise] - Diabetes, venous insufficiency, peripheral vascular disease, chronic athlete's foot, and lymphedema raise the risk SIGNS - what you find (5) - The affected skin shows blurred-edge redness that feels warm, swollen, and tender [redness] - At least two of warmth, redness, swelling, and tenderness are needed to make the diagnosis [redness] - A fluctuant, boggy feel on palpation suggests an underlying abscess is forming [abscess] - It is almost always one-sided; bilateral presentation is uncommon and should prompt a second look at the diagnosis - Blisters, an orange-peel skin texture, or swollen lymph nodes may also be documented [blisters · lymphadenopathy] TESTS (2) - Imaging of the area is not routinely recommended unless the patient has febrile neutropenia - Blood cultures are reserved for immunocompromised patients or those with an immersion injury or animal bite IF NOT THIS - what else fits (5) - Bright red, raised skin with sharply defined borders points to erysipelas rather than cellulitis, which is milder pink and flatter with blurred edges - A long-standing, bilateral rash over the inner ankles with scaling and hyperpigmentation suggests venous stasis dermatitis instead - Pain far worse than the exam findings would suggest, plus crepitus, raises concern for necrotizing fasciitis - Reduced joint movement alongside the swelling and warmth points to septic arthritis rather than simple cellulitis - One-sided leg tenderness, redness, warmth, and swelling without fever raises suspicion for deep vein thrombosis Source StatPearls "Cellulitis" - disease-level clinical article Status traced to the source above Rx: Refer for intravenous therapy | Mild, early, non-orbital only | Main treatment | If severe beta-lactam allergy | Added to cephalexin when MRSA risk factors are present REFER FOR INTRAVENOUS THERAPY 1. CEFTRIAXONE [1st line] Adult 1-2 g IV or IM once daily; immediate referral for inpatient parenteral therapy Peds 50-75 mg/kg/day [child max 2000 mg] (Child: 50-75 mg/kg once daily IV/IM (max 2000 mg daily); urgent pediatric hospital admission mandatory. The formulary's Prescribing Limits box caps a child at 2 g daily for most infections and 4 g daily for endocarditis or meningitis.) 3kg -> 150-225 mg/day 4kg -> 200-300 mg/day 5kg -> 250-375 mg/day 6kg -> 300-450 mg/day 7kg -> 350-525 mg/day 8kg -> 400-600 mg/day 9kg -> 450-675 mg/day 10kg -> 500-750 mg/day 11kg -> 550-825 mg/day 12kg -> 600-900 mg/day 13kg -> 650-975 mg/day 14kg -> 700-1050 mg/day 15kg -> 750-1125 mg/day 16kg -> 800-1200 mg/day 17kg -> 850-1275 mg/day 18kg -> 900-1350 mg/day 19kg -> 950-1425 mg/day 20kg -> 1000-1500 mg/day 21kg -> 1050-1575 mg/day 22kg -> 1100-1650 mg/day 23kg -> 1150-1725 mg/day 24kg -> 1200-1800 mg/day 25kg -> 1250-1875 mg/day 26kg -> 1300-1950 mg/day 27kg -> 1350-2000 mg/day (upper capped) 28kg -> 1400-2000 mg/day (upper capped) 29kg -> 1450-2000 mg/day (upper capped) 30kg -> 1500-2000 mg/day (upper capped) 31kg -> 1550-2000 mg/day (upper capped) 32kg -> 1600-2000 mg/day (upper capped) 33kg -> 1650-2000 mg/day (upper capped) 34kg -> 1700-2000 mg/day (upper capped) 35kg -> 1750-2000 mg/day (upper capped) 36kg -> 1800-2000 mg/day (upper capped) 37kg -> 1850-2000 mg/day (upper capped) 38kg -> 1900-2000 mg/day (upper capped) 39kg -> 1950-2000 mg/day (upper capped) 40kg -> 2000 mg/day (capped) 41kg -> 2000 mg/day (capped) 42kg -> 2000 mg/day (capped) 43kg -> 2000 mg/day (capped) 44kg -> 2000 mg/day (capped) 45kg -> 2000 mg/day (capped) 46kg -> 2000 mg/day (capped) 47kg -> 2000 mg/day (capped) 48kg -> 2000 mg/day (capped) 49kg -> 2000 mg/day (capped) 50kg -> 2000 mg/day (capped) AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), p. 246, ceftriaxone monograph, Prescribing Limits: "Pediatric Patients Endocarditis or meningitis: Maximum 4 g daily. Most other infections: Maximum 2 g daily." Why Facial cellulitis carries high risk of cavernous sinus thrombosis and intracranial extension; requires urgent IV therapy Caution Facial cellulitis (especially periorbital/nasolabial fold) requires urgent specialist referral. Do not mix or co-administer with calcium-containing IV solutions. Egypt ZOXIDEL 1 GM PD. FOR I.M. INJ. RAMEDA > DELT... 22.00 EGP CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA) KAHIRA 29.00 EGP ZOXIDEL 1 GM PD. FOR I.V. INJ. RAMEDA > DELT... 29.00 EGP WINTRIAXONE 1 GM PD. FOR I.V INJ. SANOFI 48.00 EGP VOTRIAXONE 1 GM I.M VIAL CHEMIPHARM 56.00 EGP OFRAMAX 1 GM I.M. VIAL RAMEDA > SUN ... 71.00 EGP TRIAXONE 1 GM I.M. VIAL TABUK PHARMAC... 106.00 EGP TRIAXONE 1 GM I.V VIAL TABUK PHARMAC... 106.00 EGP MILD, EARLY, NON-ORBITAL ONLY 2. AMOXICILLIN + CLAVULANIC ACID [1st line] Adult 875/125 mg orally twice daily (or 1000/200 mg IV 3 times daily) for mild, non-toxic early erysipelas without orbital signs x 5-7 days Peds 25-45 mg/kg/day [child max 1750 mg] (Child >3 months: 25-45 mg/kg/day divided BID (based on amoxicillin component)) 3kg -> 75-135 mg/day 4kg -> 100-180 mg/day 5kg -> 125-225 mg/day 6kg -> 150-270 mg/day 7kg -> 175-315 mg/day 8kg -> 200-360 mg/day 9kg -> 225-405 mg/day 10kg -> 250-450 mg/day 11kg -> 275-495 mg/day 12kg -> 300-540 mg/day 13kg -> 325-585 mg/day 14kg -> 350-630 mg/day 15kg -> 375-675 mg/day 16kg -> 400-720 mg/day 17kg -> 425-765 mg/day 18kg -> 450-810 mg/day 19kg -> 475-855 mg/day 20kg -> 500-900 mg/day 21kg -> 525-945 mg/day 22kg -> 550-990 mg/day 23kg -> 575-1035 mg/day 24kg -> 600-1080 mg/day 25kg -> 625-1125 mg/day 26kg -> 650-1170 mg/day 27kg -> 675-1215 mg/day 28kg -> 700-1260 mg/day 29kg -> 725-1305 mg/day 30kg -> 750-1350 mg/day 31kg -> 775-1395 mg/day 32kg -> 800-1440 mg/day 33kg -> 825-1485 mg/day 34kg -> 850-1530 mg/day 35kg -> 875-1575 mg/day 36kg -> 900-1620 mg/day 37kg -> 925-1665 mg/day 38kg -> 950-1710 mg/day 39kg -> 975-1750 mg/day (upper capped) 40kg -> 1000-1750 mg/day (upper capped) 41kg -> 1025-1750 mg/day (upper capped) 42kg -> 1050-1750 mg/day (upper capped) 43kg -> 1075-1750 mg/day (upper capped) 44kg -> 1100-1750 mg/day (upper capped) 45kg -> 1125-1750 mg/day (upper capped) 46kg -> 1150-1750 mg/day (upper capped) 47kg -> 1175-1750 mg/day (upper capped) 48kg -> 1200-1750 mg/day (upper capped) 49kg -> 1225-1750 mg/day (upper capped) 50kg -> 1250-1750 mg/day (upper capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) Why Oral outpatient step-down or initial treatment strictly for mild, early non-orbital cases Caution Contraindicated in penicillin allergy or history of co-amoxiclav-associated jaundice/hepatic dysfunction. Monitor for fever, visual changes, or proptosis (signals orbital cellulitis emergency). Egypt E-MOXCLAV 1G 10 F.C. TAB. EIPICO 14.00 EGP (1.40/unit) -> ? strength differs AUJED 625 MG 12 F.C. TAB. SIGMA TEC > J... 19.20 EGP (1.60/unit) -> ? strength differs E-MOXCLAV 375MG 10 F.C. TAB. EIPICO 20.40 EGP (2.04/unit) -> ? strength differs MAGNABIOTIC 625MG 8 TAB. SEDICO 37.00 EGP (4.62/unit) -> ? strength differs CURAM 625MG 12 F.C.TAB. SANDOZ > NOVA... 108.00 EGP (9.00/unit) -> ? strength differs AUGMENTIN 625 MG 10 F.C.TABS. MUP > SMITHKL... 117.00 EGP (11.70/unit) -> ? strength differs CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS. RAMEDA > ORGANOPHARMA 106.00 EGP -> ? strength differs AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETS GLAXO SMITHKLINE 169.00 EGP -> ? strength differs LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral solid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral solid MAIN TREATMENT - choose one 3. CEPHALEXIN [1st line] Adult Usual adult dosage range: Oral: 250 to 1,000 mg every 6 hours or 500 mg every 12 hours (maximum: 4 g/day). x 5 days Peds 25-50 mg/kg/day [child max 2000 mg] (Mild to moderate infection: Oral: 25 to 50 mg/kg/day divided every 6 or 12 hours; maximum daily dose: 2,000 mg/day.) 3kg -> 75-150 mg/day 4kg -> 100-200 mg/day 5kg -> 125-250 mg/day 6kg -> 150-300 mg/day 7kg -> 175-350 mg/day 8kg -> 200-400 mg/day 9kg -> 225-450 mg/day 10kg -> 250-500 mg/day 11kg -> 275-550 mg/day 12kg -> 300-600 mg/day 13kg -> 325-650 mg/day 14kg -> 350-700 mg/day 15kg -> 375-750 mg/day 16kg -> 400-800 mg/day 17kg -> 425-850 mg/day 18kg -> 450-900 mg/day 19kg -> 475-950 mg/day 20kg -> 500-1000 mg/day 21kg -> 525-1050 mg/day 22kg -> 550-1100 mg/day 23kg -> 575-1150 mg/day 24kg -> 600-1200 mg/day 25kg -> 625-1250 mg/day 26kg -> 650-1300 mg/day 27kg -> 675-1350 mg/day 28kg -> 700-1400 mg/day 29kg -> 725-1450 mg/day 30kg -> 750-1500 mg/day 31kg -> 775-1550 mg/day 32kg -> 800-1600 mg/day 33kg -> 825-1650 mg/day 34kg -> 850-1700 mg/day 35kg -> 875-1750 mg/day 36kg -> 900-1800 mg/day 37kg -> 925-1850 mg/day 38kg -> 950-1900 mg/day 39kg -> 975-1950 mg/day 40kg -> 1000-2000 mg/day 41kg -> 1025-2000 mg/day (upper capped) 42kg -> 1050-2000 mg/day (upper capped) 43kg -> 1075-2000 mg/day (upper capped) 44kg -> 1100-2000 mg/day (upper capped) 45kg -> 1125-2000 mg/day (upper capped) 46kg -> 1150-2000 mg/day (upper capped) 47kg -> 1175-2000 mg/day (upper capped) 48kg -> 1200-2000 mg/day (upper capped) 49kg -> 1225-2000 mg/day (upper capped) 50kg -> 1250-2000 mg/day (upper capped) Choice Cephalexin is the first choice here; cefazolin is a further option. Source Egyptian National Drug Formulary - Antimicrobial 2023 Why First-generation oral cephalosporin providing first-line spectrum against Group A Streptococcus and MSSA for mild nonpurulent cellulitis or step-down oral therapy. Caution Hypersensitivity to cephalexin, other cephalosporins, or any component of the formulation Egypt CEFLODIX 500 MG 12 CAPS. ARAB CAPS > P... 9.00 EGP (0.75/unit) CEPHALEXCID 500 MG 12 CAPS. CID 10.30 EGP (0.86/unit) CEPHOXIN 500MG 12 TAB. PHARCO B 10.50 EGP (0.88/unit) CEPHALEXIN 500MG 10 CAPS. ARAB DRUG COM... 10.10 EGP (1.01/unit) MEDICEFLEXIN 500 MG 20 CAPS. T3A PHARMA > ... 25.25 EGP (1.26/unit) CEPHALEXIN 500MG 12 CAPS B.P.2007 SHIFA MEDICAL PRODUCTS > O... 27.00 EGP (2.25/unit) KEFLEX 500 MG 12 CAPS. HIKMA PHARMA 58.00 EGP (4.83/unit) CEPOREX 500MG 12 TABS. GLAXO SMITHKLINE 69.00 EGP (5.75/unit) AMTHROST 125MG/5ML SUSP. 60ML SIGMA > SABAA 4.00 EGP -> ? strength differs, ? different route - not oral solid AMTHROST 250MG/5ML SUSP. 60ML SIGMA > SABAA 4.50 EGP -> ? strength differs, ? different route - not oral solid 4. CEFAZOLIN [1st line] Adult 1 to 2 g IV every 8 hours x 5 days Peds 25-100 mg/kg/day [child max 6000 mg] (General dosing, susceptible infection: Infants, Children, and Adolescents: IM, IV: Mild to moderate infections: 25 to 100 mg/kg/day divided every 8 hours; maximum daily dose: 6 g/day.) 3kg -> 75-300 mg/day 4kg -> 100-400 mg/day 5kg -> 125-500 mg/day 6kg -> 150-600 mg/day 7kg -> 175-700 mg/day 8kg -> 200-800 mg/day 9kg -> 225-900 mg/day 10kg -> 250-1000 mg/day 11kg -> 275-1100 mg/day 12kg -> 300-1200 mg/day 13kg -> 325-1300 mg/day 14kg -> 350-1400 mg/day 15kg -> 375-1500 mg/day 16kg -> 400-1600 mg/day 17kg -> 425-1700 mg/day 18kg -> 450-1800 mg/day 19kg -> 475-1900 mg/day 20kg -> 500-2000 mg/day 21kg -> 525-2100 mg/day 22kg -> 550-2200 mg/day 23kg -> 575-2300 mg/day 24kg -> 600-2400 mg/day 25kg -> 625-2500 mg/day 26kg -> 650-2600 mg/day 27kg -> 675-2700 mg/day 28kg -> 700-2800 mg/day 29kg -> 725-2900 mg/day 30kg -> 750-3000 mg/day 31kg -> 775-3100 mg/day 32kg -> 800-3200 mg/day 33kg -> 825-3300 mg/day 34kg -> 850-3400 mg/day 35kg -> 875-3500 mg/day 36kg -> 900-3600 mg/day 37kg -> 925-3700 mg/day 38kg -> 950-3800 mg/day 39kg -> 975-3900 mg/day 40kg -> 1000-4000 mg/day 41kg -> 1025-4100 mg/day 42kg -> 1050-4200 mg/day 43kg -> 1075-4300 mg/day 44kg -> 1100-4400 mg/day 45kg -> 1125-4500 mg/day 46kg -> 1150-4600 mg/day 47kg -> 1175-4700 mg/day 48kg -> 1200-4800 mg/day 49kg -> 1225-4900 mg/day 50kg -> 1250-5000 mg/day Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Parenteral first-generation cephalosporin for hospitalized patients with severe or systemic non-MRSA facial cellulitis. Caution CONTRAINDICATED in patients with hypersensitivity reactions to cefazolin or other cephalosporins. Caution should be exercised when administering cefazolin to breastfeeding women. May be associated with elevated INR, especially in nutritionally-deficient patients, prolonged treatment, or hepatic or renal disease. Prolonged use may result in fungal or bacterial superinfection, including Clostridioides difficile-associated diarrhea (CDAD) and pseudomembranous colitis. Egypt ZINOL 500 MG I.M./I.V. VIAL PHARCO B 31.00 EGP ZINOL 1 GM I.M./I.V. VIAL PHARCO B 48.00 EGP IF SEVERE BETA-LACTAM ALLERGY 5. CLINDAMYCIN [1st line] Adult 300 to 450 mg six-hourly Peds No paediatric dose for facial cellulitis in the sources opened. Source Cellulitis - StatPearls - NCBI Bookshelf (NBK549770) Why Ceftriaxone, co-amoxiclav, cephalexin and cefazolin are all beta-lactams, so a patient with a severe penicillin allergy needs something else; clindamycin covers streptococci and staphylococci including MRSA. Caution Clindamycin carries a boxed warning for severe and sometimes fatal colitis, so it is reserved for patients who genuinely cannot have a beta-lactam. Any diarrhoea during or after the course must be taken seriously as possible Clostridioides difficile infection - tell the patient to report it rather than treat it themselves. It clears more slowly in liver disease. Facial cellulitis is a referral pathway - starting oral antibiotics does not cancel the urgent referral, and orbital or spreading disease needs intravenous treatment in hospital. Egypt ADCOCLINDACE 300 MG 16 CAPS. ARAB DRUG COM... 24.00 EGP (1.50/unit) CLINACYN 300MG 16 CAPS. SIGMA > EGYPT... 31.50 EGP (1.97/unit) CLINDAM 300 MG 16 CAPS. SIGMA > OCTOB... 75.00 EGP (4.69/unit) MEPACLIND 300MG 8 CAPS. MEPACO 38.00 EGP (4.75/unit) CLINDACINE ART 300 MG 12 CAPS. RAMEDA > ART ... 76.00 EGP (6.33/unit) ALFACLINDAMYCIN 300 MG 10 CAPS. ATCO PHARMA >... 69.00 EGP (6.90/unit) DALACIN C 300MG 10 CAPS. PFIZER 114.00 EGP (11.40/unit) KLENDABIOTICAM 1 % TOP. SOLUTION PANAX PHARMA 8.50 EGP -> ? strength differs, ? different route - not oral solid ADCOCLINDACE 10MG/ML TOP. SOL. ARAB DRUG COM... 12.00 EGP -> ? strength differs, ? different route - not oral solid ADDED TO CEPHALEXIN WHEN MRSA RISK FACTORS ARE PRESENT - give alongside 6. SULPHAMETHOXAZOLE + TRIMETHOPRIM [add-on - not a substitute] Adult 800 mg / 160 mg twice a day, given together with cephalexin 500 mg every 6 hours x 5 days Peds Contraindicated in infants under 2 months. No paediatric cellulitis dose in the sources opened. Source Cellulitis - StatPearls - NCBI Bookshelf (NBK549770) Why Purulent cellulitis, an associated abscess, a puncture wound or injecting drug use all raise the chance of MRSA, and nothing else listed covers it; the combination is added to the cephalexin rather than replacing it, because on its own it covers streptococci poorly. Caution Do not give it to anyone with a sulfonamide allergy, a past sulfonamide or trimethoprim immune thrombocytopenia, folate-deficiency megaloblastic anaemia, marked liver damage, or severe renal impairment that cannot be monitored. Avoid it in late pregnancy and in infants under 2 months. It raises the INR sharply in patients on warfarin and raises potassium, particularly alongside an ACE inhibitor or a potassium-sparing diuretic. It is added to the cephalexin, not swapped for it - on its own it is unreliable against streptococci, which cause most facial cellulitis. Facial cellulitis is an urgent referral pathway; oral treatment is for mild, early, non- orbital disease only. Egypt CO-TRIMOXAZOLE 20 TABS. MUP 5.00 EGP (0.25/unit) COTRIL 400/80MG 20 TAB. EL NASR 38.00 EGP (1.90/unit) SEPTAZOLE FORTE 800/160MG 20 TABS. ALEXANDRIA 56.00 EGP (2.80/unit) SEPTRIN D.S 10 TABS. GLAXO SMITHKL... 28.00 EGP (2.80/unit) SEPTAZOLE 400/80MG 20*10 TABS. ALEXANDRIA 340.00 EGP (34.00/unit) SUTRIM 400/80MG 20*10 TAB. MEMPHIS 340.00 EGP (34.00/unit) CO-TRIMOXAZOLE 200/40MG SUSP. 120ML MUP 6.00 EGP -> ? strength differs, ? different route - not oral solid SUTRIM 200/40MG SUSP. 100ML MEMPHIS 18.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)