1

Therapeutic Care Plan for Cellulitis

Name

Institution

Course

Professor

Date
 2

Cellulitis Treatment Plan

Cellulitis is a known skin infection. It is mainly caused by Staphylococcus Aureus or

Streptococcus pyogenes infection. The number of infections, particularly in specific groups

of individuals or particular locations, is overwhelming, particularly for those of other

microorganisms such as MRSA. The infection presents clinically by erythema, induration,

and increased temperature of the affected skin, often in the lower limbs. In a practical

therapeutic approach to cellulitis, the primary goal consists of using both pharmacological

and non-pharmacological treatments, focusing on patient education to avoid relapses and

complications. It is necessary to develop a therapeutic care plan (TCP) for mild cellulitis for a

patient, applying the TCP grading criteria where required, including assessment data,

therapeutic goals, interventions, and care.

Integration of Assessment Data

Assessment is the critical component of cellulitis treatment, where clinicians often

gather subjective and objective data about the patient. Subjective data consists of a patient’s

history, including any recent trauma, insect bites, or underlying illnesses like diabetes or

venous ulcers, which, according to Brown and Hood Watson (2023), are predisposing

factors for cellulitis. Patients may use words like pain when the ailment is in a specific body

region, redness, and swelling in the affected area. It may also present constitutional

manifestations such as fever, chills, or general malaise.

Records of physical exams are part of the objective data. Some of the standard

features of cellulitis, according to Sullivan and de Barra (2019), include skin redness,

skin swelling, local skin temperature being higher than the rest of the body, and skin over the

affected area being tender when touched; this area commonly has an ill-defined border. In

more severe cases, the patient will manifest general signs such as tachycardia, fever, and

lymphangitis, which suggest a systemic infection. When the clinical presentation is

 3

considered, staphylococcus aureus and Group A Streptococcus (GAS) are the most probable

pathogens. Antibiotic treatment can always be prescribed after diagnosis, with blood cultures

or wound swabs as part of an effective pathogen search in patients with MRSA or

immunocompromised people.

Therapeutic Goals

Using goal setting in managing cellulitis requires the definition of quantifiable targets

to aid therapeutic procedures. The goals outlined below follow the SMART criteria and

address both immediate and long-term aspects of care:

Firstly, the affected site's redness, swelling, and tenderness should decrease within 48-

72 hours of administering the antibiotic treatment. Additionally, Preventing the systemic

spread of the infection is another goal. Examine the child for features of systemic disease

such as fever, generalized malaise, or an increase in the size of the rash. If these signs appear,

increase the intensity of action by changing to broader-spectrum or intravenous antibiotics.

Thirdly, it alleviates pain and discomfort. According to Ebob-Anya et al. (2019), pain

management during treatment includes using analgesics and applying cold gloves to the

treated area.

Also, the patient should be educated on skincare and prevention. Ensure that patients

with chronic edema are counseled on maintaining good skin condition, treating minor

injuries, and the importance of daily use of compression stockings to prevent reoccurrence.

Compliance with antibiotics is the final goal. Following up after 48–72 hours is necessary for

treatment checkups and monitoring for potential medication side effects. Ullah (2023)

states that the patient should complete the antibiotic dosage.

Pharmacological Interventions

Cellulitis is mainly treated using antibiotics. The Anti-infective Review Panel (2019)

discusses that the antibiotic type depends on the pathogen causing the infection and the
 4

patient's overall condition. Antibiotics that target S. aureus and S pyogenes are the first-line

treatment for cellulitis. The following courses of treatment are recommendable:

Cephalexin 500 mg PO QID for 5 to 7 days: Herman and Hashmi (2023) describe why this

is an accepted first-line antibiotic: It is practical, relatively inexpensive, and safer than many

medications.

Cloxacillin 500 mg po TID or QID: Brindle et al. (2019) describe that it is highly effective

against MRSA and penicillinase-producing staphylococci and can be used as the drug of first

choice.

Amoxicillin-Clavulanate 875 mg po BID: This combination adds new anaerobic modes for

the tougher-to-handle diseases.

In suspected cases of MRSA, the following second-line agents may be considered:

Doxycycline 100 mg PO bid for 5 to 7 days. This is a relatively inexpensive strategy for

controlling MRSA in your facility if the organisms are highly resistant.

TMP/SMX (160 mg/800 mg) twice a day: This is useful for community-acquired MRSA;

however, it is very unreliable for Streptococcus coverage, which requires exact patient

selection or added agents.

Non-drug Interventions

Lifestyle modifications are essential in preventing complications/recurrences of

cellulitis in chronic disease sufferers, such as those with lower limb edema. The following

measures are recommended:

Elevating the affected part above the level of the heart promotes venous return and

will reduce swelling or edema. Mahmoud and Mohamed (2021) explain that the patient

should be counseled to elevate the affected limb as much as possible, especially when

inactive.
 5

Cool-wet compresses: Applying cool compresses to the site of inflammation for about 15–20

minutes with an intervening period of some hours decreases the local heat and pain, thus

temporarily improving the condition.

Compression stockings: In patients with chronic swelling in the lower extremity,

compression stockings have been reported to reduce the frequency of cellulitis recurrences by

improving venous blood return to decrease limb swelling. Patients should be encouraged to

wear the socks as frequently as possible to maintain the effect.

Skin care education: Patient education about skin care, appropriate cleansing and

moisturizing, and treating minor skin trauma to minimize skin breakdown and infection

exacerbation. Furthermore, eradicating interdigital tinea pedis, if present, is essential to

reduce recurrent cellulitis.

Plan of Care

Monitoring and Follow-Up

It is crucial to control the work produced and check whether therapy interventions

continually work for the patient. Consequently, a clinical follow-up should be set within 48 to

72 hours after the commencement of therapy. Decreases in erythema, swelling, and

tenderness indicate the aim of the improvements. Further studies, like blood samples or

imaging, may be needed in case of a lack of progress or deterioration of the infection.

Laboratory and Diagnostic Testing

Further tests are required if first-choice antibiotics have not cleared the infection or

the patient has conditions such as an immunocompromised state. According to Ullah (2023),

other investigations that may be requested include blood cultures to exclude bacteremia, and

ultrasound may be initiated to look for signs of abscess formation, which may require

aspirations. A diagnostic requisition form should be included in the manual's appendix.

Consultations and Referrals

 6

If the problem's overall management is complicated or any issues recur, the patient

should be referred to an infectious disease specialist or a dermatologist. Any patient with

abscesses or clinical evidence of necrotizing fasciitis should be referred for emergency

surgical opinion.

Reflection on Learning

Excellent management of cellulitis needs to incorporate medical therapies alongside

other non-pharmacological approaches. By doing so, I learned the roles of patient-centered

care, especially in patients with chronic illnesses that quickly put them at risk of developing

repeated infections. Knowledge of preventive measures and compliance with the prescribed

treatment regimes is the key to good results. I also recognized the value of reflection and

adaptation in clinical practice, learning that each case presents unique challenges that require

continuous learning and adjustment. This has shown the importance of periodic follow-up

and modifying the care plan according to the client's reaction to the prescribed plan.

Conclusion

Cellulite treatment is a complex task that demands a multilevel approach and includes

pharmacological and non-pharmacological methods. Proper management involves using the

right antibiotics in the early stages and avoiding complications that cause the swelling. In

addition, good skin care must be taken to prevent further occurrences. As brought out by the

Therapeutic Care Plan, nurse practitioners can be assured of the best approach to their

patients concerning the immediate infection and possible future ones. Supervising and

follow-up, in addition to correcting referents, also added to the effectiveness of the treatment

plan.
 7

References

Anti-infective Review Panel. (2019). Anti-infective guidelines for community-acquired

infections. MUMS Health Clearinghouse.

Brindle, R., Williams, O. M., Barton, E., & Featherstone, P. (2019). Assessment of Antibiotic

Treatment of Cellulitis and Erysipelas. JAMA Dermatology, 155(9), 1033.

https://doi.org/10.1001/jamadermatol.2019.0884

Brown, B. D., & Hood Watson, K. L. (2023, August 7). Cellulitis. PubMed; StatPearls

Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549770/

Ebob-Anya, B.-A., Bassah, N., & Palle, J. N. (2019). Management of cellulitis and the role of

the nurse: a 5-year retrospective multicentre study in Fako, Cameroon. BMC

Research Notes, 12(1). https://doi.org/10.1186/s13104-019-4497-4

Herman, T. F., & Hashmi, M. F. (2023, August 17). Cephalexin. PubMed; StatPearls

Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549780/

Kemnic, T. R., & Coleman, M. (2022, November 28). Trimethoprim Sulfamethoxazole.

Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513232/

Mahmoud, T., & Mohamed, S. (2021). Effect of Non-Pharmacological Interventions on Pain

and Skin Erythema Associated with Cellulitis. Original Article Egyptian Journal of

Health Care, 12(1).

https://ejhc.journals.ekb.eg/article_135121_833e05bbb9d9370e6b3b56ef025a9ad0.pd

Patel, R. S., & Parmar, M. (2023). Doxycycline Hyclate. In www.ncbi.nlm.nih.gov. StatPearls

Publishing. https://www.ncbi.nlm.nih.gov/books/NBK555888/

Sarla, G. S. (2024). Cellulitis: Causative Organisms and Treatment. Research Gate.

https://www.researchgate.net/publication/377059740_Cellulitis_Causative_Organisms

_and_Treatment
 8

Sullivan, T., & de Barra, E. (2019). Diagnosis and management of cellulitis. Clinical

Medicine, 18(2), 160–163. https://doi.org/10.7861/clinmedicine.18-2-160

Ullah, N. (2023, October 3). Cellulitis: recognition and management. The Pharmaceutical

Journal. https://pharmaceutical-journal.com/article/ld/cellulitis-recognition-and-

management

Yip, D. W., & Gerriets, V. (2022). Penicillin. PubMed; StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK554560/
 9

Appendix 1

CASES Decision Aid - Templates

Legend of Symbols:
C=Cost Rate1= least expensive 5= most expensive

A=Adherence Rate1= best adherence potential 5= least adherence potential

S=Safety Rate1= most safe for client 5= least safe for the client

E=Efficacy Rate1= 1st Line, 2= 2nd Line, 3= 3rd line

S=Simplicity Rate1= most simple to use 5= least simple to use

#Minutes - Frequency - Duration Rating 1- 5 Referral

Counselling (See Legend) 

Method C A S E S

1. Elevation of the affected area 15 minutes every hour during rest 1 1 1 1 1 ✓

until the swelling subsides

2. Pain management strategies During the consultation, over-the- 2 1 1 2 2 ✓

counter analgesics should be

recommended as needed.

3. Wound care Review in 10-15 minutes at 1 2 1 1 2 ✓

consultation

#Minutes - Frequency - Duration Rating 1- 5 Referral

Health Education (See Legend) 

 10

Topic C A S E S

1. Proper skin hygiene 20 minutes during consultation 1 2 1 1 2 ✓

2. Signs of worsening infection 10 minutes during consultation 1 1 1 1 2 ✓

3. Use of compression stockings Ongoing 3 2 2 1 3 ✓

4. Completing antibiotic therapy 5 minutes during consultation 1 1 1 1 2 ✓

#Minutes - Frequency - Duration Rating 1- 5 Referral

Complementary (See Legend) 

Method C A S E S

1. Cool, wet compresses 15 minutes, 4-6 times per day 1 2 1 1 2 ✓

2. Moisturizing the skin Daily after bathing 2 2 1 1 2 ✓

3. Exercise to improve circulation 30 minutes, 3-4 times a week 1 3 2 2 3 ✓

4. Dietary modifications to reduce swelling Ongoing 2 3 1 2 3 ✓

5. Use of support devices (e.g., mobility Ongoing as needed 3 2 2 2 3 ✓

aids)
 11

6. Hydration to support skin health Ongoing 1 2 1 2 1 ✓

 12

Appendix 2

CASES Decision Aid - Templates

Legend of Symbols:

C=Cost Rate1= least expensive 5= most expensive

A=Adherence Rate1= best adherence potential 5= least adherence potential

S=Safety Rate1= most safe for client 5= least safe for the client

E=Efficacy Rate1= 1st Line, 2= 2nd Line, 3= 3rd line

S=Simplicity Rate1= most simple to use 5= least simple to use

Drug Coverage Consider what drug coverage your patient has and how this can influence

your choice of medications; if the plan covers OTC drugs, you can provide a prescription

Drug Pick Place a checkmark  for the drug that you will recommend

Condition: Cellulitis (Mild)

Primary pathogen: Staphylococcus aureus and Group A Streptococcus

Dose - Route - Rating 1- 5 Drug coverage: Drug

ODB/NIHB/OTC Pick 
RX Prescription Drug Name* Frequency - (See Legend)

& strength Duration

Select up to 5 drugs

**Consider OTC when

appropriate

f C A S E S

* Write generic on the first line

* Write trade on the second line

1. Cephalexin Per-oral 1 1 1 1 1 ODB covered ✓

Keflex/ panicking 500 mg QID for 5-7 days

2. Cloxacillin Per-oral 2 1 1 1 2 ✓
 13

Apo-cloxi/novo-cloxine/nu- 500 mg QID for 5-7 days

cloxiorbenin

3. Doxycycline Per-oral 2 2 2 2 2 ODB covered ✓

Doryx/doxy/doxy
100 mg BID for 5-7
caps/doxytab/monodox
days

4. TMP/SMX Per-oral based on 2 3 2 2 3 ODB covered ✓

Bactrim/Bactrim DS/protrin
TMP content
DX/sulfatrim
160 mg/800 mg BID

for 5-7 days

5. Amoxicillin-Clavulanate 875 mg BID for 5-7 days 3 2 1 2 4 ✓

Augmentin/ clavulin
 14

Appendix 3

Condition: Mild Cellulitis

Pathogens: Staphylococcus aureus and Group A Streptococcus

Task 1- make a diagnosis and Indication: What is the patient’s Diagnosis:
decide if treatment is indicated problem or diagnosis? Is there Cellulitis is an infection that
What are the management an indication for drug therapy? causes mild inflammation in a
issues in this patient? What are the goals of particular skin area. Some
Consider treatment? visible signs accompanying this
What are the targets of therapy, infection include redness, a
and when is drug therapy slight puffed-up appearance,
indicated? and heat; from the mentioned
clinical symptoms,
Staphylococcus aureus, and
Group A Streptococcus is the
possible cause of the infection.
Indication for Drug Therapy:
To treat the bacterial infection,
decrease inflammation, and
limit possible spread to other
sites or recurrence.
Goals of Treatment:
To relieve symptoms such as
erythema, swelling, and
tenderness within 48-72 hours
of therapy administration.
Avoid the formation of an
abscess or sepsis.
Ensure patient adherence to the
treatment regimen to prevent
recurrence or resistance.
Task 2-Identify possible Therapeutic alternatives: What Pharmacological Alternatives:
therapeutic alternatives are possible treatment Cephalexin (500 mg QID for 5-7
Consider alternatives, including non- days): An initial use for
What are effective drug? How effective are these inflammation that may only be
pharmacologic and treatment alternatives? What is mild on this layer of the skin.
nonpharmacologic alternatives the evidence to support these Herman and Hashmi (2023)
for this patient? treatment alternatives? show that it provides good
What are the differences results when used to treat
between these treatment infection resulting from
alternatives, and what evidence Staphylococcus aureus and
supports their use? Group A Streptococcus. The
Collaborate with the client on Anti-infective Guidelines
therapeutic alternatives. concerning Community-
Provide education to the client Acquired Infections (2019)
regarding contraindications and identify cephalexin as the first-
precautions. line antibiotic in situations not
involving MRSA. Cephalexin
cures a range of illnesses at a
very high success rate for 5 to
 15

Seven days.
Cloxacillin (500 mg QID for 5-7
days): Cephalexin is less
frequently prescribed than
cloxacillin. However, it is as
effective as the latter. Medical
protocols endorse it, especially
for cellulitis treatment due to
high beta-lactamase resistance.
Doxycycline (100 mg BID for 5-
7 days): An adjunct therapy
used in cases where MRSA
might be present. For MRSA,
doxycycline is an effective
antimicrobial with excellent
penetration into tissues and
bodily fluids. Although it
exhibits good activity compared
to Gram-positive organisms, it is
slightly less active against
Streptococcus species; thus, its
use is reduced in the treatment
of Viral and streptococcal
etiology is proven.
TMP/SMX (160 mg/800 mg BID
for 5-7 days): Another second-
line valuable agent in treating
MRSA. However, there is also a
relative paucity of
Streptococcus coverage, so it is
often used to treat cases with
definitive or highly probable
MRSA.
Non-Pharmacological
Alternatives:
Elevation of the affected limb:
Elevation of the affected part
above the heart level minimizes
edema and inflammation of the
tissues. It is the oldest and
safest treatment, with a strong
recommendation by research
such as the work by Mahmoud
and Mohamed (2021)for clinical
practice, the reduction and
management of edema, and
enhanced blood circulation.
Cool, wet compresses: apply a
cool compress, which has a
soothing effect on the patients
since it reduces local
 16

inflammation and relieves pain

and warmth.
Compression stockings: Strictly
using compression stockings for
various patients with chronic
lower extremity edema
decreases the susceptibility to
infective cellulitis. According to
Mahmoud and Mohamed
(2021), using them as a regular
preventive measure can achieve
better outcomes and reduce the
chance of recurrence.
Contraindications: What are the Cephalexin:
contraindications of using this Allergies: Cephalexin is
drug in this patient, including contraindicated in patients with
allergies or intolerances, major known hypersensitivity to
organ failure (renal, hepatic, penicillin or Cephalosporin since
cardiac, etc), and concomitant about 10% of patients with
disease? penicillin allergy are cross-
sensitive to Cephalexin. Hence,
it is crucial to check for allergy
history before prescribing.
Renal impairment: There will be
a need for dose adjustment to
avoid toxicity in patients with
moderate to severe renal
impairment.
Gastrointestinal disorders: This
medication can worsen the
signs of some types of GI
disorders, such as colitis or
disease of an irritated bowel.
Use caution in patients with a
history of diarrhea after
receiving antibiotics or
pseudomembranous colitis.
Cloxacillin:
Allergies: The side effects of
cloxacillin are similar to those of
cephalexin; therefore, it should
not be recommended for
individuals with a history of
penicillin or cephalosporin
allergic reaction due to cross-
sensitivity.
Hepatic impairment: Although
kidneys excrete most of the
cloxacillin, the drug is given
judiciously to patients with
severe hepatic disease due to
 17

possible hepatotoxicity of the

drug in the diseased patients.
Renal impairment: The dose
should be reduced in moderate
to severe renal impairment due
to reduced clearance, which
leads to toxicity.
Doxycycline:
Allergies: Contraindicated in
patients with a history of allergy
to tetracycline antibiotics.
Lactation and Pregnancy: Patel
and Parmar (2023) recommend
the avoidance of Doxycycline in
pregnant and lactating females
due to its major adverse effects,
including tooth discoloration
and inhibition of bone growth,
seen in developing fetuses and
infants.
Renal and hepatic impairment:
Doxycycline does not need
dosage adjustment in patients
with renal impairment.
However, the drug should be
used cautiously in patients with
liver impairment because of the
risk of hepatotoxicity.
TMP/SMX:
Allergies: It is not indicated for
patients with a history of
allergic reactions to Sulphur
because this drug may result in
Stevens-Johnson syndrome.
Renal impairment: TMP/SMX
should not be used in patients
with severe renal disease unless
the appropriate dose
adjustments have been made. It
may lead to hyperkalemia in
these patients.
Hepatic impairment: Care is
required in patients with
impaired hepatic function, as
this agent may precipitate
hepatic toxicity.

Precautions: Is the patient Pregnancy/Lactation:

pregnant or lactating? What Cephalexin can be used during
clinical examination, laboratory pregnancy and breastfeeding.
indices, or diseases must be No effects of teratogenicity
 18

considered before selecting a were found. However, it is

drug? What drug-disease necessary to monitor
interactions need to be frequently.
considered? What drug-drug Doxycycline: These are
interactions need to be contraindicated in pregnant and
considered? lactating women, as they affect
the bone and tooth
development of the fetus.
TMP/SMX: causes neural tube
disorder; hence, not for
pregnant women, especially
during the first three months. It
can also lead to the
development of kernicterus.
Clinical Examination and
Laboratory Works:
Liver function tests should be
done to evaluate kidney
function because patients who
take cephalexin, cloxacillin, or
TMP/SMX may be at greater
risk.
Serum liver tests are required
for those patients who are likely
candidates to be given
doxycycline or cloxacillin
because these drugs may be
hepatotoxic to patients with
liver disease.
A complete blood count (FBC)
may be needed to assess for
hematologic changes, especially
in patients on TMP/SMX.
Drug-Disease Interactions:
Cephalexin/Cloxacillin:
According to Yip and Gerriets
(2022), it is unsuitable for
patients with gastrointestinal
diseases, especially those with a
history of antibiotic-associated
colitis.
Doxycycline: risky for patients
with hepatic impairment
because of potential
hepatotoxicity.
TMP/SMX is contraindicated in
patients with a history of folate
deficiency and those with
severe renal impairment.
Administer with caution to
patients with G6PD deficiency
 19

since it causes hemolysis.

Drug-Drug Interactions:
Cephalexin/Cloxacillin: it affects
the action of oral
contraceptives. Therefore,
clients using them should be
encouraged to use backup
contraception.
Doxycycline: Antacids, iron
preparations, minerals, and
calcium-rich foods may
decrease its uptake. Hence,
Patients should be advised to
take doxycycline with a glass of
water, preferably on an empty
stomach.
TMP/SMX: Its interaction with
warfarin may increase the
chance of bleeding. Patients on
anticoagulants and changes in
INR (International Normalized
Ratio) should be closely
monitored. Additionally, It also
interacts with ACE inhibitors
and ARBs, increasing the risk of
hyperkalemia.
Task 3: Select a medication for a Cost: Does a drug plan cover Cephalexin: People with
specific patient this medication, or can the prescriptions captured under
Consider patient afford it? ODB often get cephalexin
Select the best medication(s) for antibiotics, as this medication is
this patient, considering all the generally included under most
potentially effective treatment drug plans.
alternatives. The following The patient is willing to choose
factors will assist in the the specific drug among the list
selection of the best agent. of interchangeable biologics
Of all the treatment alternatives because its cost will be covered
available, what is the best under the Ontario Drug Benefit
pharmacologic choice for this (ODB) and NIHB (Non-Insured
patient? Justify your response Health Benefits). Cephalexin is
based on efficacy, best still relatively cheap compared
evidence, and suitability. Why to other antibiotics, so it will not
were other therapeutic pose a financial problem for any
alternatives ruled out in this patient who does not have a
case? drug plan. For uninsured
patients, typically, the entire
course is less than $20.
Doxycycline and TMP/SMX:
These second-line treatments
are also usually the types of
drugs covered under drug plans,
though they are slightly more
 20

costly than cephalexin and,

depending on insurance, even
doxycycline. Still, both are
relatively inexpensive to most
patients in their respective
quantities.
Compliance: Do any Cephalexin: Compliance is
considerations need to be essential because cephalexin is
made? to be administered four times a
day (QID). This is typical when
using antibiotics but may be
inconvenient for most people
with Schedules or poor memory
to remember several doses
daily. It will be essential to
educate the patients because
they will need to adjust to the
new schedule to continue an
initially effective treatment
plan.
Doxycycline: Brindle et al.
(2019) explain that it needs to
be taken twice daily(BID), which
is quite an improvement
compared to cephalexin
regarding ease of patient
compliance. In patients who
may need the hassle of having
multiple doses a day,
doxycycline could be more
convenient, though it’s not the
first choice unless MRSA is
suspected.
TMP/SMX: Like doxycycline,
TMP/SMX should be taken BID,
retaining a relatively convenient
dosing regimen for the patient
compared to QID dosing.
Efficacy Are there any patient- Cephalexin: Due to
related factors relating to Staphylococcus aureus and
efficacy that influence my Group A Streptococcus,
decision? cephalexin is the initial
treatment recommended for
most patients. However, if there
is suspicion of MRSA, cephalexin
may not be sufficient, and a
second-line agent, including
doxycycline or TMP/SMX,
should be used. Supervision is
necessary to determine the
effectiveness of the treatment
 21

for patients with immune-

compromising diseases.
Doxycycline is more valuable for
MRSA, as Staphylococcus
aureus and MRSA cause the
infection, but less effective
against Group A Streptococcus.
Thus, it should only be used
initially if an infection by MRSA
is expected.
TMP/SMX: it is efficacious
against MRSA but incapable of
eradicating Group A
Streptococcus; hence, it is not
suitable for treatment for
patients who do not have
MRSA.
Adverse effects: What are Cephalexin:
common and potentially severe Side effects include nausea,
adverse effects that can occur vomiting, diarrhea, and stomach
with this drug? Will these side pain. Less common side effects
effects affect my choice of include hypersensitivity
therapeutic alternative for this reactions like rash, itching, or
patient? anaphylactic reactions. Others
Provide education to the client include antibiotic-associated
regarding adverse effects. diarrhea and C. difficile
infection.
Education for the patient:
Advise them to take the
medication with food if they
suffer from nausea. Inform
them of the completion of total
dosages. Inform the patient of
the side effects and ask them to
contact a healthcare provider if
these occur.
Doxycycline may cause some
degrees of nausea, vomiting,
and photosensitivity, and it
poses a threat of irritation to
the esophagus; rare side effects
include Stevens-Johnson
syndrome or hepatotoxicity in
case of liver deformities.
Education for the patient: take
doxycycline with a full glass of
water and avoid lying down for
at least 30 minutes after taking
the medication to prevent
irritation of the esophagus.
Avoid direct sunlight and wear
 22

sunscreen to prevent sunburn

due to increased
photosensitivity. Report to the
clinic immediately if they
develop a skin rash or severe
gastrointestinal manifestation.
TMP/SMX: Kemnic and
Coleman (2022) explain that
they include gastrointestinal
disturbances, especially nausea,
vomiting, and rash, as well as
hyperkalemia. Severe
complications are committed by
Stevens-Johnson syndrome,
toxic epidermal necrolysis, and
blood dyscrasias, including
aplastic anemia or
agranulocytosis.
TMP/SMX has also been linked
to renal toxicity in some
patients, particularly those with
underlying renal disease.
TMP/SMX is contraindicated in
patients with a known
sensitivity to sulfa products
since this may result in severe
allergic reactions.
Education for the patient: It is
recommended that the patient
swallow the medication as
directed and take adequate
water to avoid forming crystals
in the kidneys. They should also
watch for a severe rash that
may point toward anaphylaxis
and should reach the clinic if
they develop serious side
effects – for instance, a
persistent cough, bruising, or
tiredness. Further, the patient
should be watched for
hyperkalemia when on other
drugs like ACE inhibitors or
diuretics.
Task 4: Decide on the dose, Dosage/Duration: What is an Dosage: 500 mg per oral after
frequency, and duration for the appropriate dose for this every 6 hours (QID).
patient patient? What is the duration of Duration: 7 days.
Consider treatment? Rationale: This dosing is
What is the best starting dose adequate for mild cellulitis and
for this patient? is compatible with the
What is the best strategy for recommended first-line
 23

dose escalation? antibiotics. A short course (5-7

What is the target dose? days) is sufficient for resolving
symptoms and preventing
recurrence while minimizing the
risk of bacterial resistance.
Task 5: Provide directions and Directions: What instructions Medication Name: Cephalexin
information to the patient on should I give the patient 500 mg
medication use regarding name, indication, Administration: Swallow one
Consider rationale for choice, how to use tablet whole with water and
What instructions should I give or administer, adverse effects, take it orally every six hours for
the patient regarding dosage contraindications, precautions, seven days.
and administration? monitoring for effectiveness, Education:
What will I need to include and when to come back for an Why this medication:
regarding instructions on the assessment? Cephalexin is chosen because it
prescription efficiently works on the bacteria
infecting the body.
How to take: Swallow the entire
capsule with or without meals,
meaning one should keep the
dosage time the same as that of
their doctor. Always complete
the course as outlined, even if
the symptoms improve during
the overall course period.
Common side effects: The side
effects include gastrointestinal,
with nausea or diarrhea being
the most widespread. Contact
the clinic if you have developed
severe side effects such as
allergic reactions, rash, swelling,
or difficulty breathing.
Precautions: Advise the patient
not to skip doses and to keep
the drug in a cool, dry area.
Inform them to report to the
healthcare provider if there is
no improvement within 48-72
hours or if the infection
worsens.
Monitoring: Use the
observation method to check,
among other things, whether
there is any indication of
efficacy through reduced
redness, swelling, and pain.
Return to the clinic in case of
worsening symptoms or the
geographical spread of the
infection.
Task 6 Identify what needs to Monitoring and follow-up: How Monitoring:
 24

be monitored will I know if this drug is Assess the reduction of

Consider effective for this patient? What erythema, swelling, and
What signs, symptoms, and are the targets of drug therapy? tenderness after 48-72 hours of
laboratory parameters would When and how often do I starting therapy.
you monitor for this patient? measure them? How will I know Look for features of generalized
Do I need to consult another if this drug is causing problems? sepsis, such as fever or
provider for monitoring? What is the follow-up? extension of erythema
What follow-up is needed with Any consultation with another peripheral; these may signal the
the client? health care provider? need for admission to the
hospital or alteration of the
antibiotic regimen.
Follow-Up:
Each treatment course
demands a review within 48-72
hours to determine the
patient’s response to the
treatment plan. If there is no
improvement, consult with an
infectious disease specialist
regarding a change in the
antibiotic. According to Brown
and Hood Watson (2023), If
cellulitis worsens, a shift in the
treatment plan may be
necessary, along with obtaining
a blood culture or imaging like
an ultrasound.
Consultation:
If the patient’s condition does
not improve or if they have new
symptoms they did not have
before the tumor formation,
then the diagnosis of a tumor is
warranted.
Consequences (for instance,
abscess development): the
patient should be sent to an
infectious disease specialist or a
surgeon for additional
consultation and management.
Adapted from NP-PHC Program content