CREST Guidelines on The Management of Cellulitis in Adults

Cellulitis in adults is a common medical condition taking up a large number of occupied bed days in Acute hospitals. Consequently, it represents an important healthcare issue with substantial resource and financial implications for the majority of acute trusts. In Northern Ireland in 2003, there were 2,081 admissions with discharge diagnosis of cellulitis, with average length of stay of 11 days.

Inappropriate diagnosis is a problem and cellulitis must be differentiated from lower leg eczema, oedema with blisters, acute venous problems including deep venous thrombosis (DVT), thrombophlebitis and liposclerosis, and vasculitis.

Despite the size of the problem, there is a relative lack of good evidence-based literature for the management of patients with cellulitis. There is only one published set of guidelines using a systematic approach and no national guidelines. Trials of treatment options are often small and inconclusive. No randomised controlled trials or observational studies look at the effects of treating predisposing factors on the recurrence of cellulitis or erysipelas. As a result of this clinical practice is variable and often inconsistent.

Under the auspices of the Clinical Resource Efficiency Support Team (CREST), a sub-group chaired by Dr Raymond Fulton, Consultant Dermatologist, Altnagelvin Hospital, comprising health care professionals from varied backgrounds, was established to produce guidelines on The Management of Cellulitis in Adults.

The CREST guidelines on the Management of Cellulitis in Adults were launched at a half-day conference, on Thursday 16 June 2005, at the Hilton Hotel, Templepatrick. Approximately 300 delegates from the various specialties involved in the management of cellulites, including the public and private sectors, attended the conference.

CREST would like to thank Dr Raymond Fulton, the members of the sub-group and all those who contributed in any way to the production of these guidelines. Further copies of the guidelines and laminated wall-chart can be obtained from the  This email address is being protected from spambots. You need JavaScript enabled to view it.

  • Cellulitis Chart  (PDF 136 KB)
  • Cellulitis Guide  (PDF 680 KB)

Speakers Presentations

  • Why Are We Here - Fulton Presentation  (1100 KB)
  • Crest Cellulitis Guidelines - Loughrey Presentation  (PDF 264 KB)
  • Treatment of Cellulitis in Lymphoedema - Garvey Presentation  (622 KB)
  • Implementation of Guidelines - Harper Presentation  (PDF 150 KB)
  • Outpatient and Home Parenteral Antibiotic Therapy - Nathwani Presentation  (PDF 269 KB)
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