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)
vascular insufficiency (venous stasis or arterial insufficiency + inadequate elevation)
alternative diagnosis (e.g. venous stasis, drug reaction, etc.)
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