I have been dealing with cellulites for over 3 weeks now. I am on azithromycin and omnicef for lyme. I got a couple of bug bites on each of my lower legs. Waited a few days to go in cause I thought the antibiotics that i was already on would take care of it, but it didn't. I went to doc and she said I have cellulites and added doxycycline. That took care of the one leg but not the other. So i went back to the docs was taken off of the doxy and put on levequin. It didn't help much, so went back, and am now on ceftin. Still taking the azithromycin, but not the omnicef. It's been six days now and my leg is still somewhat red, hurts, and is still warm. I have never had cellulites before, but sure thought I would be over it by now! Any suggestions, or advice would be appreciated, cause I sure don't know what to do!
This is what infectious diseases doctors refer to as "keflex negative cellulitis". In other words, the fact that it's gone on this long means it's likely not an infection.
The most accurate way to diagnose a cellulitis is to actually cut out a small piece of skin and culture it in the lab or look at it under the microscope. While that is the best, it's obviously not practical to do that. Soooo, as a substitute for culturing bacteria in a skin biopsy, the second best way is to look at the skin and see if you can find effects on the skin secondary to infection being there. These are the primary signs of inflammation, and the one doctors use the most to diagnose cellulitis is redness. The pitfall of this, however, is that skin redness, if you're using it as a sign of infection, can fail you. YES, cellulitis can make the skin red, but so can a lot of other things! In fact, as you are all well aware, something as simple as a sunburn can do it.
Keeping that in mind, let's assume you actually DO have cellulitis. What are some reasons that the redness isn't going away?
1. The one family doctors often assume is that you are not treating the offending bug with the correct antibiotic. While this can sometimes happen (i.e. with cellulitis secondary to water exposure) it's usually not the case. The vast majority of cellulitis is caused by Streptococcus species which are highly susceptible to antibiotics like keflex or penicillin.
2. I'm not sure about your health history but do you have diabetes or problems with the vessels in your legs? In these cases, because the vessels are not normal. they can stay dilated and maintain the red colour long after the infection is gone. In other words, the infection is completely gone, but it takes a few extra days for the redness to go away. This is common in people who has some form of vascular insufficiency in their legs.
3. The diagnosis is not an infection at all! This does NOT sound like the case in you, but sometimes things like clots in the leg (i.e. a DVT) can present with redness in the skin which mimics cellulitis.
In any case, while cellulitis from infections tends to rapidly resolve with antibiotics, there are patients in whom it doesn't. As long as the patient is otherwise well (i.e. doesn't have a fever, still has his appetite, and is otherwise going on with life) it's advisable to just sit back, treat with a SINGLE course of antibiotics and watch/wait. Many doctors are loathe to do this because they're afraid. Having seen lots of cellulitis, more experienced physicians will stand back, watch and eventually it resolves.