ReviewAntibiotic prophylaxis for preventing recurrent cellulitis: A systematic review and meta-analysis
Introduction
Cellulitis of the lower extremities is an acute, painful and potentially serious infection of the skin and subcutaneous tissue associated with significant morbidity1, 2 and healthcare costs.3, 4, 5 Erysipelas or uncomplicated cellulitis refers to non-suppurative, acute and spreading skin infection. Specifically, erysipelas tends to be more superficial and has prominent lymphatic involvement; while cellulitis extends deeper and involves subcutaneous tissues. We will use the terms erysipelas and cellulitis interchangeably in this paper. Risk factors for developing cellulitis of the leg include prior history of cellulitis, lymphoedema, toe web maceration, obesity and diabetes.6, 7, 8, 9
Cellulitis is typically caused by b-haemolytic streptococci of group A, less often by group B, C, or G streptococci or Staphylococcus aureus.10, 11 Prior history of cellulitis is strongly associated with acute cellulitis.7, 12
An attack of acute cellulitis may lead to a vicious circle of impaired lymphatic function leading to increased susceptibility to further recurrences of cellulitis.13
However, the causal association is not clear.14, 15
In 2003, 428,274 patients were hospitalized in the US with a principle diagnosis of cellulitis, with cellulitis being responsible for 1.1% of all hospital discharges.16 Sixteen to 30% of patients who have had a first episode of erysipelas or uncomplicated cellulitis will subsequently develop a recurrence.17, 18, 19
There is disagreement about how effective antibiotic prophylaxis is for preventing recurrent cellulitis. We undertook a systematic review and meta-analysis to evaluate the level and quality of available evidence regarding the efficacy and reported adverse effects of antibiotic prophylaxis against recurrent cellulitis.
Section snippets
Methods
This systematic review protocol was registered with PROSPERO on 11th September 2012 with registration number CRD42012002528.
Results
Our literature search yielded 1472 articles from all sources. Fig. 1 shows the numbers of studies screened, resulting in five studies that matched our criteria.21, 22, 23, 24, 25, 26 Of these, two studies were done by the UK's ‘Prophylactic Antibiotics for the Treatment of Cellulitis at Home’ (PATCH) group.24, 25, 26
There were 535 participants from all five studies, with 260 participants taking antibiotics and 275 participants on placebo or not taking any antibiotics. There were 209 males and
Discussion
Antibiotic prophylaxis reduced the risk of recurrent cellulitis compared to no antibiotic prophylaxis, with an RR of 0.46 (95% CI 0.26–0.79) in patients with a history of cellulitis. This review also suggests that in patients with two or more baseline episodes of cellulitis, antibiotic prophylaxis seemed to half the recurrence of cellulitis as compared to no antibiotic prophylaxis; while not statistically significant (RR 0.35, 95% CI 0.12–1.02) this finding hints to a possibly clinically
Funding
Nasia Safdar is supported by a MERIT award from the Department of Veterans Affairs. The views in this paper do not necessarily represent the views of the authors' employers, nor the Department of Veterans Affairs.
Acknowledgements
The authors would like to thank Dr Melina Willlson for her translation work in Ref. 21.
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2018, Clinical Microbiology and InfectionCitation Excerpt :One of the drivers of this study was to explore the potential impact of interventions such as vaccination against GAS or antibiotic prophylaxis as potential control strategies. At present, the only intervention shown in randomized controlled trials to prevent recurrent LLC is prophylactic penicillin, reducing the risk by approximately 50% [18]. In these trials, prophylactic penicillin reduced the risk of LLC recurrence while on treatment, but this effect did not persist once the medication was ceased.
Top 10 Myths Regarding the Diagnosis and Treatment of Cellulitis
2017, Journal of Emergency MedicineCitation Excerpt :Lesson 9: Antibiotic prophylaxis has been shown to be effective in suppressing infection and decreasing rates of recurrence, but recurrence may occur despite adherence to therapy. Treatment of causes of infection and optimization of treatment of other disease states may decrease the risk of recurrence (50–52). A study of 398 cases compared to 8005 controls discovered 40% of patients experienced cellulitis recurrence despite prophylactic treatment with benzathine penicillin.
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Ko is now at the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia.