Early Response in Cellulitis: A Prospective Study of Dynamics and Predictors

Abstract

In this prospective study of cellulitis, several nonpharmacological factors were associated with lack of early response. Such early nonresponse was rarely related to inappropriate therapy but strongly predictive of early treatment escalation, suggesting that broadening antibiotic treatment often may be premature.

Which outcomes are reported in cellulitis trials? Results of a review of outcomes included in cellulitis trials and a patient priority setting survey

“…Assessing treatment response at this earlier time point may increase the reliability of the measurement of drug effect, because the outcome is not confounded by natural improvement of disease. 23 Moreover, this end point is in line with the 2013 FDA guidance recommending early clinical response as the primary outcome. 12 Patient-focused outcomes such as patient-reported pain, treatment satisfaction and quality of life were rarely reported.…”

“…Some of the more recent trials used ‘early clinical response’ as the primary outcome, defined as the cessation of lesion spread (measured as the length × width of lesion) 48–72 h after treatment initiation. Assessing treatment response at this earlier time point may increase the reliability of the measurement of drug effect, because the outcome is not confounded by natural improvement of disease . Moreover, this end point is in line with the 2013 FDA guidance recommending early clinical response as the primary outcome…”

A prospective observational cohort study in primary care practices to identify factors associated with treatment failure in Staphylococcus aureus skin and soft tissue infections

“…This finding is in contrast to a recent study that found longer duration of symptoms was among the factors related to early response (at day 3). However, the investigation evaluated antibiotic response at day 3 among hospitalized SSTI patients; therefore, may not necessarily be associated with long-term outcomes including post-treatment failure and recurrence that were evaluated in the current study [7]. Importantly, this finding further supports the proposition that time to effective treatment is essential in the management of SSTIs, and possibly, that patients presenting with longer duration (≥7 days) of infections may require more aggressive measures and/or follow-up monitoring.…”

“…SSTIs due to CA-MRSA have been implicated to have more serious outcomes compared to community-associated methicillin susceptible S. aureus (CA-MSSA) SSTIs; however, there are limited studies evaluating the differences in treatment outcomes in the primary care setting. Furthermore, while there has been a growing body supporting the assessment of early response in treatment failure among hospitalized patients with SSTIs, very little information is available for outpatients [7, 8]. Tools to better identify those who are at higher risk of experiencing treatment failure are needed to better inform treatment decisions in the outpatient setting.…”

Diagnosis and management of cellulitis

“…bd = twice daily; PO = oral; IV = intravenous; qds = four times daily CME Infectious diseases first 3 days of therapy) did not result in improved outcomes and addressing non-antibiotic factors such as limb elevation and treatment of comorbidities should be considered as an integrated part of the clinical management of cellulitis. 23 Outpatient parenteral antimicrobial therapy has become an increasingly important means of delivering ambulatory care. Cellulitis was the most common primary infective diagnosis in UK OPAT Outcomes registry in 2015.…”