Cellulitis severity and follow-up workflow

Primary care cellulitis workflow for severity grading, early failure detection, and escalation thresholds.

Medium-risk workflowLast reviewed September 4, 2026

AI-assisted evidence review. Clinical-owner sign-off is not recorded for this update.

Scope

Use for

Initial outpatient skin/soft tissue infection management with planned reassessment.

Not for

Suspected necrotizing infection or sepsis requiring immediate emergency pathway.
Inpatient IV antimicrobial management protocols.

Assess vitals, progression, skin breaks, comorbidities and oral intake; distinguish nonpurulent cellulitis from abscess, venous dermatitis or another mimic.
Document site and extent. Bites, water exposure, diabetic foot infection and infection near the eye require separate assessment and antimicrobial selection.

Treat these as urgent. Escalate early if concern persists or follow-up is unreliable.

Emergency transfer for shock, confusion, rapidly progressive infection, pain out of proportion or suspected necrotizing infection; do not await outpatient testing.
Eye pain with movement, reduced vision or proptosis suggests orbital involvement and needs emergency assessment.
Escalate for systemic deterioration, inability to take oral therapy or failure of outpatient treatment.

Mild nonpurulent cellulitis can usually receive an oral antibiotic active against streptococci, such as cephalexin, after checking allergy, renal function and local guidance. MRSA coverage is not automatic.
An abscess needs assessment for drainage and culture; purulent infection requires a separate treatment decision.
A 5-day course is often adequate when improving; reassess before extending. Confirm local dosing and duration for the patient and infection site.
Mark margins, elevate the affected limb and address edema or skin disease.

Arrange a trajectory check within 24-48 hours. Reassess if improvement has not begun within 2-3 days or deterioration occurs sooner.
Some early extension of redness can occur; assess pain, systemic state and progression together. Rapid or substantial spread needs urgent reassessment.

Return precautions you can say as written:

“If symptoms get worse, new warning signs appear, or you cannot follow the plan from this visit, seek urgent care now.”

Point to the red flags above that apply to this patient.
Confirm follow-up timing and where to go after hours.
Attach a relevant handout to reinforce the plan.
Document disposition, rationale, unresolved uncertainty, and that precautions were understood.

Clinical owner: Family Medicine Editorial Team
Risk tier: Medium
Review cadence: Every 6 months
Last reviewed: September 4, 2026AI-assisted evidence review. Clinical-owner sign-off is not recorded for this update.
Review status: Evidence current. Next review due March 4, 2027.