Interventions for cellulitis and erysipelas
- 16 June 2010
- journal article
- research article
- Published by Wiley in Emergencias
- Vol. 2020 (12), CD004299
- https://doi.org/10.1002/14651858.cd004299.pub2
Abstract
Cellulitis and erysipelas are now usually considered manifestations of the same condition, a skin infection associated with severe pain and systemic symptoms. A range of antibiotic treatments are suggested in guidelines. To assess the efficacy and safety of interventions for non‐surgically‐acquired cellulitis. In May 2010 we searched for randomised controlled trials in the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and the ongoing trials databases. We selected randomised controlled trials comparing two or more different interventions for cellulitis. Two authors independently assessed trial quality and extracted data. We included 25 studies with a total of 2488 participants. Our primary outcome 'symptoms rated by participant or medical practitioner or proportion symptom‐free' was commonly reported. No two trials examined the same drugs, therefore we grouped similar types of drugs together. Macrolides/streptogramins were found to be more effective than penicillin antibiotics (Risk ratio (RR) 0.84, 95% CI 0.73 to 0.97). In 3 trials involving 419 people, 2 of these studies used oral macrolide against intravenous (iv) penicillin demonstrating that oral therapies can be more effective than iv therapies (RR 0.85, 95% CI 0.73 to 0.98). Three studies with a total of 88 people comparing a penicillin with a cephalosporin showed no difference in treatment effect (RR 0.99, 95% CI 0.68 to 1.43). Six trials which included 538 people that compared different generations of cephalosporin, showed no difference in treatment effect (RR 1.00, 95% CI 0.94 to1.06). We found only small single studies for duration of antibiotic treatment, intramuscular versus intravenous route, the addition of corticosteroid to antibiotic treatment compared with antibiotic alone, and vibration therapy, so there was insufficient evidence to form conclusions. Only two studies investigated treatments for severe cellulitis and these selected different antibiotics for their comparisons, so we cannot make firm conclusions. We cannot define the best treatment for cellulitis and most recommendations are made on single trials. There is a need for trials to evaluate the efficacy of oral antibiotics against intravenous antibiotics in the community setting as there are service implications for cost and comfort.Keywords
This publication has 98 references indexed in Scilit:
- The efficacy and safety of daptomycin vs. vancomycin for the treatment of cellulitis and erysipelasInternational Journal of Clinical Practice, 2009
- Meropenem Versus Imipenem-Cilastatin for the Treatment of Hospitalized Patients with Complicated Skin and Skin Structure Infections: Results of a Multicenter, Randomized, Double-Blind Comparative StudySurgical Infections, 2005
- Flucloxacillin alone or combined with benzylpenicillin to treat lower limb cellulitis: a randomised controlled trialEmergency Medicine Journal, 2005
- Intramuscular bipenicillin vs. intravenous penicillin in the treatment of erysipelas in adults: randomized controlled studyJournal of the European Academy of Dermatology and Venereology, 2004
- Once‐Daily, High‐Dose Levofloxacin versus Ticarcillin‐Clavulanate Alone or Followed by Amoxicillin‐Clavulanate for Complicated Skin and Skin‐Structure Infections: A Randomized, Open‐Label TrialClinical Infectious Diseases, 2002
- Treatment of hospitalized patients with complicated Gram-positive skin and skin structure infections: two randomized, multicentre studies of quinupristin/dalfopristin versus cefazolin, oxacillin or vancomycinJournal of Antimicrobial Chemotherapy, 1999
- A Randomised Comparative Study of Once-Daily Ceftriaxone and 6-Hourly Flucloxacillin in the Treatment of Moderate to Severe CellulitisClinical Drug Investigation, 1996
- Double-blind, double-dummy comparison of azithromycin and cephalexin in the treatment of skin and skin structure infectionsEuropean Journal of Clinical Microbiology & Infectious Diseases, 1991
- Ticarcillin plus clavulanic acid versus moxalactam in the treatment of skin and soft tissue infectionsAmerican Journal Of Medicine, 1985
- Sulbactam/ampicillin: effects on glucose metabolism in diabetics with soft tissue infectionJournal of Antimicrobial Chemotherapy, 1985