Best Practice for Cellulitis with Lymphoedema

Distinguishing between ‘red legs’ and cellulitis in these patients can be difficult (Cellulitis or Red Legs Flowchart). However once established, the following may be a useful guide.

The British Lymphology Society and The Lymphoedema Support network Consensus Guidelines on the management of Cellulitis makes recommendations which are reviewed annually about the use of antibiotics for lymphoedema patients with cellulitis, at home and in hospital.

Below is a brief overview, but we recommend you read the full document.



first-line antibiotics

if allergic to penicillin

second line antibiotics


ano-genital cellulitis

Hospital:Acute cellulitis +/- septicaemia

IV Flucloxacillin 2g 6hly

clindamycin 600mg 6hly

clindamycin 600mg 6hly if poor response after 48 hrs

switch to oral amoxicillin 500mg 8hly or clinidamycin 300mg 6 hly

amoxicillin 2g 8hly IV plus gentamicin 5mg/kg IV daily

At home: acute cellulitis

oral amoxicillin 500mg 8 hrly

erythromycin 500mg 6 hly or clarithromycin 500mg 12 hly

clindamycin 300 mg 6hly if poor response after 48 hrs

if evidence of staph aureus infection: flucloxacillin 500mg 6 hrly

prophylaxis to prevent recurrent cellulitis (if 2+ attacks p.a.)

penicillin V 250mg bd (500g bd if BMI> 33)

erythromycin 250mg bd or clarithromycin 250mg daily

if inadequate trial of clindamicin 150mg dialy or cefalexin 125mg daily

dose may be reduced to 250mg daily after one year successful prophylaxis. May need to be lifelong if relapse occurs after 2 year succesfull prophylaxis

trimethoprim 100mg daily taken at night

emergency supply of AB in case of need/away from home

amoxicillin 500 mg tds

erythromycin 500mg qds or clarithromycin 500mg bd.

AB should be started immediately, but a medical opinion should be sought as soon as possible


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