Efficacy of Oral β-Lactam versus Non-β-Lactam Treatment of Uncomplicated Cellulitis

Madaras‐Kelly, Karl; Remington, Richard; Oliphant, Catherine M.; Sloan, Kevin L.; Bearden, David T.

doi:10.1016/j.amjmed.2008.01.028

Cited by 29 publications

(17 citation statements)

References 18 publications

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“…At least four trials have been published since the release of the 2005 IDSA guidelines comparing beta lactams to antimicrobial agents with activity against CAMRSA in cases of outpatient cellulitis [8, 31, 34]. Two studies [8, 34] evaluated “uncomplicated cellulitis” defined as non-purulent cellulitis or minimal purulence, not associated with ulcers or other complex lesions.…”

Section: Studies Of Empirical Coverage For Cellulitismentioning

confidence: 99%

Is Community-Acquired Methicillin-Resistant Staphylococcus aureus Coverage Needed for Cellulitis?

Horseman

Bowman

2013

Infect Dis Ther

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Methicillin-resistant Staphylococcus aureus (MRSA) has become the dominant strain of Staphylococcus aureus in many communities of the United States. As a result, many clinicians are now empirically covering for this pathogen in the treatment of various skin and soft-tissue infections. Should this practice apply to cellulitis? In order to answer this question, we defined cellulitis and reviewed the pathogenesis, microbiology, and current studies of inpatient and outpatient antimicrobial therapy. The current evidence suggests empirical MRSA coverage for community-acquired cellulitis may not be necessary in non-purulent (non-suppurative) forms of this infection. Most cases are non-purulent and not amenable to culture although antibody studies indicate streptococci are the most common etiologic agents. Current studies of antimicrobial therapy tend to agree with this finding. Empirical beta-lactam therapy directed primarily at streptococci appears sufficient for non-purulent cellulitis regardless of the prevalence of MRSA in the community.

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Section: Studies Of Empirical Coverage For Cellulitismentioning

confidence: 99%

Is Community-Acquired Methicillin-Resistant Staphylococcus aureus Coverage Needed for Cellulitis?

Horseman

Bowman

2013

Infect Dis Ther

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“…25 We found that MRSA-active agents – most commonly trimethoprim-sulfamethoxazole – were prescribed in approximately 60% of uncomplicated cellulitis cases. This suggests a lack of understanding of the microbiology of cellulitis or may simply reflect discomfort in not covering for MRSA.…”

Section: Discussionmentioning

confidence: 92%

Avoidable Antibiotic Exposure for Uncomplicated Skin and Soft Tissue Infections in the Ambulatory Care Setting

Hurley

Knepper

Price

et al. 2013

The American Journal of Medicine

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Background Uncomplicated skin and soft tissue infections are among the most frequent indications for outpatient antibiotics. A detailed understanding of current prescribing practices is necessary to optimize antibiotic use for these conditions. Methods This was a retrospective cohort study of children and adults treated in the ambulatory care setting for uncomplicated cellulitis, wound infection, or cutaneous abscess between March 1, 2010 and February 28, 2011. We assessed the frequency of avoidable antibiotic exposure, defined as: use of antibiotics with broad gram-negative activity, combination antibiotic therapy, or treatment for 10 or more days. Total antibiotic-days prescribed for the cohort were compared to antibiotic-days in four hypothetical short-course (5 – 7 days), single-antibiotic treatment models consistent with national guidelines. Results 364 cases were included for analysis (155 cellulitis, 41 wound infection, and 168 abscess). Antibiotics active against methicillin-resistant Staphylococcus aureus were prescribed in 61% of cases of cellulitis. Of 139 cases of abscess where drainage was performed, antibiotics were prescribed in 80% for a median of 10 (interquartile range 7 – 10) days. Of 292 total cases where complete prescribing data were available, avoidable antibiotic exposure occurred in 46%. This included use of antibiotics with broad gram-negative activity in 4%, combination therapy in 12%, and treatment for 10 or more days in 42%. Use of the short-course, single-antibiotic treatment strategies would have reduced prescribed antibiotic-days by 19 – 55%. Conclusions Nearly half of uncomplicated skin infections involved avoidable antibiotic exposure. Antibiotic use could be reduced through treatment approaches utilizing short courses of a single antibiotic.

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“…The microorganism was recovered more frequently among patients with abscess (15% vs 8%) or cSSTI (56% vs 25%) than in patients with uncomplicated cellutitis (29% vs 67%, p = 0.001). Patients with positive microbiology results had longer duration of treatment (median [IQR]: 18 [15-29.5] vs 15 [12][13][14][15][16][17][18][19] days, p = 0.003) and longer hospital stay (11 [7][8][9][10][11][12][13][14][15][16][17] vs 8 [5][6][7][8][9][10][11][12][13] days, p = 0.014).…”

Section: Discussionmentioning

confidence: 99%

“…This has been associated with an increase in in-hospital mortality, a longer duration of antibiotic treatment and hospital stay and, higher costs 14 . Factors associated with treatment failure are age, severity, bite wounds and the Charlson index 17 . However, in our study, no factor was found to be associated with a higher failure rate, and although the duration of hospitalisation and time of antibiotic treatment were greater in these patients, no significant difference was demonstrated.…”

Section: Antibiotic Regimesmentioning

confidence: 99%

Tratamiento empírico de pacientes ingresados con infección de piel y partes blandas: ¿cómo lo estamos haciendo?

Pérez-Rodríguez¹,

Argibay²,

Nodar³

et al. 2014

Gal. Clin.

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ResumenObjetivos: Existen diferentes guías de tratamiento de la infección de piel y partes blandas (IPPB), sin embargo el tratamiento de estos pacientes es muy variable. Los objetivos fueron analizar las pautas antibióticas, así como su duración en pacientes con IPPB que precisaron ingreso. Pacientes y métodos: Se revisaron los pacientes con IPPB ingresados entre enero y diciembre de 2009. Se recogieron las pautas de tratamiento antibiótico empleadas antes, durante y tras el ingreso, así como su duración. Resultados: De un total de 131 pacientes con IPPB ingresados, se identificaron 41 pautas diferentes de tratamiento antibiótico. En 61 pacientes (47%) se emplearon dos o más fármacos y en 21 (16%) antibióticos de amplio espectro. En 25 pacientes (19%) se modificó la pauta antibiótica por mala evolución y se utilizaron 16 regímenes antibióticos diferentes. En los pacientes con fracaso del tratamiento antibiótico, ni la duración del ingreso (12 ± 9.0 días vs. 14 ± 8.7 días, p = 0.31), ni la duración del tratamiento antibiótico (12 ± 8.2 días vs. 14 ± 6.8 días, p = 0.33) fueron superiores a la de aquellos en los que la respuesta al tratamiento empírico inicial fue adecuada. Al alta, 95 pacientes (73%) recibieron tratamiento antibiótico, se identificaron 25 regímenes diferentes; 22 pacientes (23%) recibieron dos o más antibióticos y antibióticos de amplio espectro se pautaron en 10 casos. Conclusiones: La IPPB es una causa creciente de hospitalización y, a pesar de existir guías recientes de tratamiento, las pautas de tratamiento antibiótico son altamente variables. Palabras clave: Celulitis; infección de piel y partes blandas; absceso cutáneo; tratamiento antibiótico. AbstractObjetives: There are several clinical guidelines for the management of skin and soft tissue infections (SSTI); however, the empirical treatment of patients with this common cause of hospital admission is highly variable. The aims of this study were to determine the empirical antibiotic treatment regimes and the duration of antibiotic treatment of SSTI requiring hospitalization. Patients and methods: Cases admitted for SSTI were reviewed. We evaluated antibiotic therapy before, during and after hospitalization, as well as duration of treatment. Results: From the 131 patients, 41 different antibiotic regimes were identified. Antibiotic combinations were used in 61 patients (47%) and broadspectrum antibiotics were used in 21 patients (16%). Modification of the antibiotic regimen was required in 25 patients (19%) due to poor clinical response, and 16 different regimes were prescribed. For patients with treatment failure, neither duration of hospitalization (12 ± 9.0 days vs. 14 ± 8.7 days, p = 0.31) nor duration of antibiotic treatment (12 ± 8.2 days vs. 14 ± 6.8 days, p = 0.33) were greater than for those who responded to the initial empirical treatment. On discharge, antibiotic treatment was prescribed for 95 patients (73%), with 25 different regimes, including a combination of drugs in 22 patients (23%) and broad-spectrum antibiotics in 10. Con...

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Efficacy of Oral β-Lactam versus Non-β-Lactam Treatment of Uncomplicated Cellulitis

Cited by 29 publications

References 18 publications

Is Community-Acquired Methicillin-Resistant Staphylococcus aureus Coverage Needed for Cellulitis?

Is Community-Acquired Methicillin-Resistant Staphylococcus aureus Coverage Needed for Cellulitis?

Avoidable Antibiotic Exposure for Uncomplicated Skin and Soft Tissue Infections in the Ambulatory Care Setting

Tratamiento empírico de pacientes ingresados con infección de piel y partes blandas: ¿cómo lo estamos haciendo?

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