Increased Therapeutic Failure for Cephalexin versus Comparator Antibiotics in the Treatment of Uncomplicated Outpatient Cellulitis

Abstract

We reviewed records of outpatients to determine the therapeutic failure rate of cephalexin in treating uncomplicated cellulitis. Therapeutic failure was defined as an increase in antibiotic dosage, prescription renewal, or addition or substitution of another antibiotic. Demographics, physical characteristics, risk factors, intervention, and outcome data were collected. Twenty-seven percent of patients failed therapy with an oral antibiotic. The failure rate for cephalexin was 40% versus 20% for comparator antibiotics (p=0.02, odds ratio [OR] 2.62, 95% confidence interval [CI] 1.18-5.75). We identified no statistically significant variables related to cephalexin failure. Concomitant acid suppressive therapy was administered with cephalexin in 42% of failures and 20% of nonfailures (p=0.11, OR 2.78, 95% CI 0.77-9.87). These data suggest that cephalexin's efficacy was less than that of other antimicrobials in treating cellulitis, possibly related to concurrent acid suppression.

Comparison of Short-Course (5 Days) and Standard (10 Days) Treatment for Uncomplicated Cellulitis

“…One recent description of therapy for uncomplicated cellulitis in an outpatient clinic noted an overall 27% failure rate for oral antibiotic therapy. 26 Four of our own subjects (out of 121, or 3%) did not show improvement at all by the fifth day of therapy, and so we excluded them from randomization. Although they eventually had resolution of their cellulitis after 10 to 14 days of therapy, we did not consider them eligible for short-course therapy.…”

Microbiology of Surgical Site Infections Complicating Breast Surgery

“…Furthermore, 30% of patients with cephalexinsusceptible organisms required a change in therapy because of clinical failure. Previously published data [12] suggest a higher failure rate with the use of cephalexin for treatment of skin and soft tissue infections. In one study, cephalexin had a 40% failure rate in the treatment of uncomplicated cellulitis, as defined by an increase in dosage, renewal of the prescription, or addition or substitution of another antimicrobial agent compared with a 20% failure rate for other comparable firstline antibiotics.…”

Therapeutic experience with cefdinir in the treatment of uSSSIs

“…One particularly important finding in this study was that eight children with cephalexin‐resistant pathogens (most commonly S. aureus and Enterococcus faecalis ) were successfully treated with cefdinir, serving to confirm its potent antimicrobial profile (7). Such clinical success rates appear consistent with cefdinir, while in contrast, other cephalosporins such as cephalexin have been associated with variable clinical success with some studies suggesting failure rates of up to 40% (8).…”