Once‐Daily Intravenous Cefazolin Plus Oral Probenecid Is Equivalent to Once‐Daily Intravenous Ceftriaxone Plus Oral Placebo for the Treatment of Moderate‐to‐Severe Cellulitis in Adults

Grayson, M Lindsay; McDonald, Malcolm; Gibson, Kimberley; Athan, Eugene; Munckhof, Wendy; Paull, Phillip; Chambers, Fran

doi:10.1086/340056

Cited by 71 publications

(70 citation statements)

References 15 publications

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“…In that study, 11% required a change of antibiotic therapy and 7% required admission [13]. Once-daily cefazolin with oral probenecid or daily ceftriaxone administered in the outpatient setting were found to be equivalent in a A c c e p t e d M a n u s c r i p t 14 randomised controlled trial in Australia (with 86% and 96% cure, respectively) and were associated with a mean of 6-7 days of OPAT [14]. A c c e p t e d M a n u s c r i p t A c c e p t e d M a n u s c r i p t 1 A c c e p t e d M a n u s c r i p t 1 A c c e p t e d M a n u s c r i p t 1 …”

Section: Of 24mentioning

confidence: 93%

Factors associated with outcome and duration of therapy in outpatient parenteral antibiotic therapy (OPAT) patients with skin and soft-tissue infections

Seaton¹,

Sharp²,

Bezlyak³

et al. 2011

International Journal of Antimicrobial Agents

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. Factors associated with outcome and duration of therapy in outpatient parenteral antibiotic therapy (OPAT) patients with skin and softtissue infections. International Journal of Antimicrobial Agents, Elsevier, 2011, 38 (3) This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. SSTIs were observed; 84% were treated with daily ceftriaxone and 15% with teicoplanin (three daily loading doses then three times per week). Progression of infection was observed in 2.8% of cases, inpatient management was required in 6% and significant adverse events occurred in 7.1%. Overall OPAT success was 87.1%.Female sex, diabetes and treatment with teicoplanin were independently associated with OPAT failure. A significant reduction in duration of OPAT therapy was observed over time. A longer duration of intravenous therapy was associated with meticillinresistant Staphylococcus aureus (MRSA), older age, vascular disease, a diagnosis of bursitis, and treatment with teicoplanin. Non-inpatient referrals, management via a nurse-led patient group direction, and treatment with ceftriaxone were associated with reduced duration of OPAT. For selected patients with SSTIs, OPAT was generally safe and effective, but specific patient groups were identified with more complex management pathways and poorer outcomes.

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Section: Of 24mentioning

confidence: 93%

Factors associated with outcome and duration of therapy in outpatient parenteral antibiotic therapy (OPAT) patients with skin and soft-tissue infections

Seaton¹,

Sharp²,

Bezlyak³

et al. 2011

International Journal of Antimicrobial Agents

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“…These 2 treatment regimens are both widely used in the ED treatment of cellulitis and allow for once daily visits and antibiotic dosing. [1][2][3]8 Patients treated with oral antibiotics alone were prescribed cephalexin 500 mg 4 times daily for 7-10 days. …”

Section: Antibiotic Treatmentmentioning

confidence: 99%

“…Many of these patients are now being treated without being admitted, using intravenous (IV) therapy through the ED or Day Hospital setting. [1][2][3][4][5] Problems may arise from such a change in patient care. The use of a wide variety of antibiotics, doses and dosing schedules, and involvement of multiple physicians with different practice patterns may have made the treatment both haphazard and confusing for patients and physicians.…”

Section: Introductionmentioning

confidence: 99%

Treatment failure in emergency department patients with cellulitis

Murray

Stiell

Wells

2005

CJEM

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Objective: To identify the rate of treatment failure in emergency department patients with cellulitis. Methods: This prospective observational convenience study enrolled adult patients with uncomplicated cellulitis. Physicians performed a standardized assessment prior to treatment. To calculate the interrater reliability of the assessment, duplicate data collection forms were completed on a small subsample of patients. Treatment failure was defined as the occurrence of any one of the following events after the initial emergency department visit: incision and drainage of abscess; change in antibiotics (not due to allergy/intolerance); specialist consultation; or, hospital admission. Comparison of means and proportions between the 2 groups was performed with univariate associations, using parametric or non-parametric tests where appropriate. Results: Seventy-five patients were enrolled; 57% were male, the mean age was 48 (standard deviation 19), 71 (95%) patients had extremity cellulitis and 10 (13%) had abscess with cellulitis. Fourteen episodes (18.7%, 95% confidence interval [CI] 11%-28%) were classified as treatment failures, with an oral antibiotic failure rate of 6.8% (95% CI 2%-22%) and an emergency department-based intravenous antibiotic failure rate of 26.1% (95% CI 16%-40%). Patients with treatment failure were older (mean age 59 yr v. 46 yr, p = 0.02) and more likely to have been taking oral antibiotics at enrolment (50% v. 16.4%, p = 0.01). Patients with a larger surface area of infection were also more likely to fail treatment (465.1 cm 2 v. 101.5 cm 2 , p < 0.01). Interrater agreement was high for the presence of fever (kappa 1.0) and the size of surface area of infection (intraclass correlation coefficient 0.98), but low for assessments of both severity (kappa 0.35) and need for admission (kappa 0.46). Conclusions:The treatment of cellulitis with daily emergency department-based intravenous antibiotics has a failure rate of more than 25% in our centre. Cellulitis patients with a larger surface area of infection and previous (failed) oral therapy are more likely to fail treatment. Further research should focus on defining eligibility for treatment with emergency department-based intravenous antibiotics. RÉSUMÉObjectif : Déterminer le taux d'échec dans le traitement des patients atteints de cellulite au dé-partement d'urgence. Méthodes : Cette étude d'observation prospective d'un échantillon de commodité incluait des patients adultes atteints de cellulite non compliquée. Les médecins effectuèrent une évaluation standardisée avant le traitement. Afin de calculer la fiabilité inter-évaluateurs de l'évaluation, des doubles de formulaires de collecte de données furent remplis pour un petit sous-groupe de

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“…Among SSTI interventional studies, there is no consistent definition but rather a range of end points from complete resolution of symptoms to stabilization or regression of the size of erythema. [21][22][23] We hypothesized that photodocumentation (PD) may assist in physician decision making, allowing earlier step-down to oral therapy. This in turn could lead to fewer ED visits, improved patient flow, and decreased costs.…”

Section: Ré Sumémentioning

confidence: 99%

Photodocumentation as an emergency department documentation tool in soft tissue infection: a randomized trial

Lund

Joo

Lewis

et al. 2013

CJEM

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Objectives: Current documentation methods for patients with skin and soft tissue infections receiving outpatient parenteral anti-infective therapy (OPAT) include written descriptions and drawings of the infection that may inadequately communicate clinical status. We undertook a study to determine whether photodocumentation (PD) improves the duration of outpatient treatment of skin and soft tissue infections. Methods: A single-blinded, prospective, randomized trial was conducted in the emergency departments of a community hospital and an academic tertiary centre. Participants included consecutive patients age $ 14 years presenting with noninvasive skin and soft tissue infections requiring OPAT. Patients in the intervention arm were treated with standard of care plus PD at each emergency physician assessment. Control subjects received care provided at the discretion of the treating physician and non-photographic documentation. The primary outcome was duration of therapy measured in half-days. The required sample size to detect a difference of one half-day was 253 patients per group (a 5 0.05). Secondary outcomes included (1) completion and therapeutic failure rates, (2) patient satisfaction, and (3) physician and nurse satisfaction. Results: Enrolment was slower and follow-up rates lower than anticipated, and the trial was terminated when funds were exhausted. A total of 468 subjects with similar age and gender characteristics were enrolled, with 244 receiving the intervention and 224 in the control arm. The mean OPAT duration was similar in the two groups (3.6 days v. 3.5 days, p 5 0.73). No differences in the rate for completion and therapeutic failure were observed (71% v. 68% and , 1% for both, respectively). Survey response rates varied significantly: patients, 65%; nurses, 17%; and physicians, 87%. Physicians endorsed more comfort with their assessment and OPAT judgment with PD (65% and 64%, respectively).Physicians cited too much time lost with technological challenges, which would affect implementation in a busy ED. Conclusions: PD as an intervention is acceptable to patients and has reasonable endorsement by the majority of physicians. This trial had significant limitations that threatened the integrity of the study, so the results are inconclusive. RÉ SUMÉObjectif: Les moyens actuels de documentation des infections de la peau et des tissus mous chez les patients soumis à un traitement anti-infectieux parenté ral ambulatoire (TAIPA) comprennent les descriptions é crites et les croquis des tissus infecté s, mais ces moyens peuvent ne pas rendre pleinement l'é tat clinique. Aussi avons-nous mené une é tude visant à dé terminer si la photodocumentation (PD) pouvait amé liorer la duré e du traitement des infections de la peau et des tissus mous chez les patients externes. Mé thode: Un essai prospectif, à ré partition alé atoire, et à simple insu a é té mené au service des urgences d'un hô pital communautaire et d'un centre hospitalier universitaire de soins tertiaires. Ont participé à l'essai des pati...

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Once‐Daily Intravenous Cefazolin Plus Oral Probenecid Is Equivalent to Once‐Daily Intravenous Ceftriaxone Plus Oral Placebo for the Treatment of Moderate‐to‐Severe Cellulitis in Adults

Cited by 71 publications

References 15 publications

Factors associated with outcome and duration of therapy in outpatient parenteral antibiotic therapy (OPAT) patients with skin and soft-tissue infections

Factors associated with outcome and duration of therapy in outpatient parenteral antibiotic therapy (OPAT) patients with skin and soft-tissue infections

Treatment failure in emergency department patients with cellulitis

Photodocumentation as an emergency department documentation tool in soft tissue infection: a randomized trial

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