Cellulitis | Notion

The Eron classification system can be used to guide how we manage patients with cellulitis:

Class	Features
I	There are no signs of systemic toxicity and the person has no uncontrolled co-morbidities
II	The person is either systemically unwell or systemically well but with a co-morbidity (for example peripheral arterial disease, chronic venous insufficiency, or morbid obesity) which may complicate or delay resolution of infection
III	The person has significant systemic upset such as acute confusion, tachycardia, tachypnoea, hypotension, or unstable co-morbidities that may interfere with a response to treatment, or a limb-threatening infection due to vascular compromize
IV	The person has sepsis syndrome or a severe life-threatening infection such as necrotizing fasciitis

They recommend the following that we admit for intravenous antibiotics the following patients:

Has Eron Class III or Class IV cellulitis.
Has severe or rapidly deteriorating cellulitis (for example extensive areas of skin).
Is very young (under 1 year of age) or frail.
Is immunocompromized.
Has significant lymphoedema.
Has facial cellulitis (unless very mild) or periorbital cellulitis.

Management is guided by the Eron classification.

Eron Class I

oral antibiotics NICE
oral flucloxacillin as first-line treatment for mild/moderate cellulitis
oral clarithromycin, erythromycin (in pregnancy)or doxycycline is recommended in patients allergic to penicillin

Eron Class II

NICE recommend: 'Admission may not be necessary if the facilities and expertise are available in the community to give intravenous antibiotics and monitor the person - check local guidelines.'

Eron Class III-IV