Choosing Wisely:

Don’t routinely use antibiotics to treat bilateral swelling and redness of the lower leg unless there is clear evidence of infection.

Rationale and Comments: Research has suggested that bilateral lower leg cellulitis is very rare. Patients with swelling and redness of both legs most likely have another condition, such as dermatitis resulting from leg swelling, varicose veins, or contact allergies. To ensure appropriate treatment, doctors must consider the likelihood of diagnoses other than cellulitis when evaluating swelling and redness of the lower legs. Misdiagnosis of bilateral cellulitis can lead to overuse of antibiotics and subject patients to potentially unnecessary hospital stays.
Sponsoring Organizations:
  • American Academy of Dermatology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Infectious disease
  • Dermatologic
  • References: • Arakaki RY, Strazzula L, Woo E, Kroshinsky D. The impact of dermatology consultation on diagnostic accuracy and antibiotic use among patients with suspected cellulitis seen at outpatient internal medicine offices: a randomized clinical trial. JAMA Dermatol. 2014 Oct;150(10):1056-61.
    • Hughey LC. The impact dermatologists can have on misdiagnosis of cellulitis and overuse of antibiotics: closing the gap. JAMA Dermatol. 2014 Oct;150(10):1061-2.
    • Hepburn MJ, Dooley DP, Ellis MW. Alternative diagnoses that often mimic cellulitis. Am Fam Physician. 2003 Jun 15;67(12):2471.
    • David CV, Chira S, Eells SJ, Ladrigan M, Papier A, Miller LG, Craft N. Diagnostic accuracy in patients admitted to hospitals with cellulitis. Dermatol Online J. 2011 Mar 15;17(3):1.
    • Levell NJ, Wingfield CG, Garioch JJ. Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care. Br J Dermatol. 2011 Jun;164(6):1326-8.
    • Kroshinsky D, Grossman ME, Fox LP. Approach to the patient with presumed cellulitis. Semin Cutan Med Surg. 2007 Sep;26(3):168-78. • Hirschmann JV, Raugi GJ. Lower limb cellulitis and its mimics: part I. Lower limb cellulitis. J Am Acad Dermatol. 2012 Aug;67(2):163.e1-12; quiz 175-6. • Hirschmann JV, Raugi GJ. Lower limb cellulitis and its mimics: part II. Conditions that simulate lower limb cellulitis. J Am Acad Dermatol. 2012 Aug;67(2):177.e1-9; quiz 185-6.

    Email Alerts

    Don't miss a single issue. Sign up for the free AFP email table of contents.

    Sign Up Now