- Cellulitis is a bacterial skin infection that causes inflammation of the inner layers of skin and subcutaneous tissue. It commonly affects the legs and develops when bacteria enter through breaks in the skin. - A 60-year old male patient was admitted with swelling, pain and tenderness in his left foot and was diagnosed with cellulitis based on his symptoms, medical history of diabetes, and CT scan results. - He was started on a treatment regimen including antibiotics like metronidazole, tramadol for pain, and diclofenac gel to address the infection, symptoms, and prevent complications.

1. CASE
PRESENTATIO
N
ON
CELLULITIS
PRESENTED BY:
AKKI YAMUNASRIVALLI
PHARM-D 3rd YR
ROLL NO: 13
BROWNS COLLAGE OF PHARMACY

2. • A 60 year old male patient admitted
with the chief complaints of with
swelling , heavy pain and tenderness
in his left foot.

3. SUBJECTIVE
INFORMATION

4. •PATIENT NAME : XXXXX
•AGE : 60 yrs
•SEX : MALE
•IP NUMBER : 1698
•DEPARTMENT :ORTHOPEDIC
•WEIGHT : 80 kgs

5. • PAST MEDICAL HISTORY : NIL
PAST MEDICATION HISTORY :NIL
• SOCIAL HISTORY
SMOKER : NO
ALCOHOL : YES
MARITAL STATUS : MARRIED

6. OBJECTIVE
INFORMATION

7. VITAL SIGNS:
DURATION DAY 1 DAY 2 DAY 3
TEMERATURE
102 100 100
BP 110/80 110/70 120/60
PULSE 83 82 88

8. PROVISIONAL
DIAGNOSIS
It might be a case of
“CELLULITIS” developed
due to in-present diabetis.

9. LAB INVESTIGATIONS
PARAMETERS NORMAL VALUES OBSERVEDVALUES
Haemoglobin M:14-16,F:13-15 11.2gm
WBC COUNT 4000-11000cells/cmm 17,300cell/cmm
DC: NEUTROPHILS 40-80% 82%
ESINOPHILS 1-6% 7%
BASOPHILS 1-2% 3%
LYMPHOCYTES 20-40% 45%
MONOCYTES 2-10% 15%
BLOOD SUGAR: RBS 80-140 mg/dl 110mg/dl
FBS 80-100mg/dl 90mg/dl
PPBS 120-160mg/dl 140mg/dl

10. CT SCAN:
A clear observation of the swelled portion of the foot due to
cellulitis condition. The depth of infection can be observed.

11. DIAGNOSIS
Based on CT-SCAN report and
clinical manifestations, it is identified
as “cellulitis”
11

12. PLAN
S.no DRUGS FREQUENCY DOSE Day 1 Day 2 Day 3 Day 4
1. Metrogyl
(metranidazole)
BD 500mg
+ + + +
2. Tramadol
(ultram)
BD 50mg
+ + + +
3. Voveran(diclofe
nac sodium)
BD 100gm
+ + + +
4. Taxim
(cefataxime)
BD 250mg
+ + + +
5. Rantac
(rantidine)
BD 150mg
+ + + +
6. Dicloxacillin BD
250mg + − + +
7. Ampicillin
(omnipen)
BD 500 ml
+ + + +

13. PHARMACISTS
INTERVENTION:
•Patients should be encouraged to inspect their feet daily and
to apply water-based moisturizer.
•Elastic socks should be avoided, as they impair circulation .
•Do not take METROGYL if you are allergic to medicines
containing metronidazole, any other nitroimidazole medicine.
•TRAMADOL should not be consumed if you have used
alcohol, sedatives, tranquilizers, or narcotic medications
within the past few hours. TRAMADOL can slow or stop your
breathing, especially when you start using this medicine or
whenever your dose is changed. Never take tramadol in
larger amounts, or for longer than prescribed .

14. •Before taking AMPICILLIN, tell your doctor or
pharmacist if you are allergic to it; or to PENICILLIN or
CEPHALOSPORIN ANTIBIOTICS; or if you have any
other allergies. This product may contain inactive
ingredients, which can cause allergic reactions.

15. CELLULITIS
• Cellulitis is a bacterial infection involving
Inflammation of subcutaneous connective
tissue i.e. the inner layers of the skin. It
specifically affects the dermis and the
subcutaneous fat.
• The legs and face are the most common
sites involved, though cellulitis can occur
on any part of the body.
• The leg is typically affected following a
break in the skin

16. ETIOLOGY:
 Cellulitis is a condition caused by bacterial infection like
Staphylococcus aureus (S. aureus) and Streptococcus
pyogenes (S. pyogenes), or by a wide variety of exogenous
bacteria.
 Bacteria enter into the body in many ways: Broken
skin, burns, insect bites, surgical incisions and
intravenous (IV) catheters are all potential pathways.

17.  Many other bacteria causes cellulitis.
Haemophilus influenza causes fascial cellulitis in young
children.
 Pasteurella multocida leads to cellulitis associated with
animal bites, mostly those of cats.
 Aeromonas hydrophila can cause an aggressive form of
cellulitis in a laceration sustained in fresh water.
 Gram-negative bacillary (rod) cellulitis, like P.
aeruginosa, is common among hospitalized,
immunocompromised patients and may have multidrug
resistance.

18. When bacteria enters the skin, it leads to redness and
swelling around the site of the infection. If the bacteria gets
into the bloodstream or into the deeper layers of the skin,
complications can occur.
 Areas where the skin is dry and flaking, broken, or
wounded are the most likely sites for bacteria to enter the
body.
Insect bites may also transmit bacteria that can cause a skin
infection.
 The pathophysiology of cellulitis commonly starts out
affecting the lower leg. The infected skin may be red, swollen,
and painful to the touch. The red rash area may get worse or
spread over time.
PATHOPHYSIOLOGY

19. • Any condition that causes chronic skin disruption, such as
eczema, can increase a skin infection.
•The cellulitis can be made more severe by a weakened
immune system caused by conditions such as diabetes
or HIV.
Chronic cellulitis can damage the lymphatic system and
cause chronic swelling of the infected area.
•In rare cases, the bacteria can spread to the fascial lining, a
deep layer of skin tissue. This is a very severe complication
and a medical emergency.

20. INFECTED FOOT WITH CELLULITIS
• Chronic stage of cellulitis left untreated causing heavy
damage in the foot

21. CELLULITIS EFFECTING EYE
An open wound in the eye causing cellulitis

22. CELLULITIS
IN
HAND
An open wound in the
hand causing cellulites
due bacterial infection

23. SIGNS AND
SYMPTOMS:
Pain and tenderness in the affected area.
 Redness or inflammation on your skin.
Tight and swollen appearance of the skin.
 A feeling of warmth in the affected area.
 Fever.

24. RISK FACTORS:
Injury. Any cut, fracture, burn gives bacteria an entry point.
Weakened immune system. Conditions that weaken your
immune system — such as diabetes, leukemia and HIV/AIDS —
leave you more susceptible to infections. Certain medications,
such as corticosteroids, also can weaken your immune system.
Skin conditions. Skin disorders — such as eczema, athlete's
foot, chickenpox and shingles — can cause breaks in the skin
and give bacteria an entry point.
Chronic swelling of your arms or legs (lymphedema).
Swollen tissue may crack, leaving your skin vulnerable to
bacterial infection.

25. HISTORY OF CELLULITIS:
People who previously had cellulitis,
especially of the lower leg, may be more prone to develop
it again.
•INTRAVENOUS DRUG USE:
People who inject illegal drugs have a higher
risk of developing cellulitis.
•OBESITY:
Being overweight or obese increases your
risk of developing cellulitis and having recurring
episodes.

26. COMPLICATIONS:
 Blood poisoning.
 Abscesses.
 Necrotising fasciitis.
 And also meningitis.

27. DIAGNOSIS:
• The condition of cellulitis is diagnosed by using
computerized tomography (CT scan).
• CT scan:
CT is used to accurately differentiate between
superficial cellulitis and deep cellulitis(cellulitis
associated with deep-seated infection).
• In uncomplicated cellulitis, CT demonstrates skin
thickening, septation of the subcutaneous fat, and
thickening of the underlying superficial fascia.

28. Goals of treatment:
Generally the treatment of cellulitis is done based on
the severity of infection. The treatment involves the
following :
When there is acute or early stage of cellulitis the
patient is treated with the anti microbial therapy by giving
a list of antibiotics and said to be used for one month and
medication should be used until the prescribed medicines
are finished.
The IV and IM treatment is given in the following
conditions ,
 1.If the infection is severe.
 2. If the patient have other medical problems

29. 3.If the effected person is very young or very old.
4.If the cellulitis involves areas close to important
structures; for example, infection around the eye socket.
DRUGS SPECIFICALLY USED:
 DICLOXACILLIN- 250 mg (OR) CEPHALEXIN- 500 mg
is given orally T.I.D in the acute infections.
 Clindamycin or a macrolide (CLARITHROMYCIN OR
AZITHROMYCIN) are reasonable alternatives in patients
who are allergic to penicillin.
 Usually, cellulitis is presumed to be due to
staphylococci or streptococci infection and may be
treated with CEFAZOLIN, CEFUROXIME, CEFTRIAXONE,
NAFCILLIN, OR OXACILLIN

30. STANDARD
TREATMENT
DRUGS GENERIC NAME DOSAGE FREQUENCY
Cefuroxime Zinacef 250mg BD
IV Clindamycin Cleocin 300mg/50ml OD
Levofloxacin Levaquin 500mg OD
IV Doripenem Doribax 500mg OD

31. Thank you……..