In general, we expand antibiotics too soon in cellulitis, as clinical response (e.g. reduction in edema/erythema, decrease in WBC count, defervesence) can take 48-72 hours. For patients who are not improving by 72H, in addition to “wrong bug/wrong drug” that would support switching antibiotics, also consider the following: lack of source control (e.g. abscess, osteomyelitis) bacteremia vascular insufficiency (venous stasis or arterial insufficiency + inadequate elevation) alternative diagnosis (e.g. venous stasis, drug reaction, etc.) #EBM #ID #Management #Cellulitis #Timeline #Progression #PrematureEscalation
