Route and duration of antibiotic therapy in acute cellulitis: A systematic review and meta-analysis of the effectiveness and harms of antibiotic treatment

Cross, Elizabeth; Jordan, Harriet; Godfrey, Rebecca; Onakpoya, Igho; Shears, Annalie; Fidler, Katy; Peto, Timothy E. A.; Walker, A.S.; Llewelyn, Martin J.

doi:10.1016/j.jinf.2020.07.030

Cited by 16 publications

(10 citation statements)

References 70 publications

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“…21 In addition, a systematic review of adult literature found that 30% to 50% of patients eligible for PO therapy receive IV antibiotics and many patients remain on IV antibiotics longer than necessary. 22 Multiple studies included in the review found no difference in treatment effectiveness between IV and PO treatment groups with similar rates of relapse. 23,24 This posits that more children who receive IV antibiotics could be safely discharged on PO antibiotics without increased risk of treatment failure or serious complication.…”

Section: Discussionmentioning

confidence: 99%

“…Invasive bacterial infections are rare in immunocompetent children with uncomplicated cellulitis; one retrospective study of 104 neonates with afebrile skin and soft tissue infections found no evidence of bacteremia 21 . In addition, a systematic review of adult literature found that 30% to 50% of patients eligible for PO therapy receive IV antibiotics and many patients remain on IV antibiotics longer than necessary 22 . Multiple studies included in the review found no difference in treatment effectiveness between IV and PO treatment groups with similar rates of relapse 23,24 .…”

Section: Discussionmentioning

confidence: 99%

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Management of Children With Uncomplicated Cellulitis in Emergency and Hospital Settings

St. Cyr,

Jaffe,

McMahon

et al. 2023

Pediatr Emer Care

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Objective The aim of the study is to establish consensus recommendations on features used to determine the route of antibiotic administration and disposition for children with uncomplicated cellulitis. Methods Modified Delphi methodology was performed with 2 rounds of confidential surveys of Emergency medicine and hospital medicine (HM) providers at Lurie Children's Hospital to assess cellulitis management in children (ages 6 months–18 years) without signs of sepsis or abscess formation. Using a 9-point Likert scale, emergency medicine providers ranked features by perceived level of importance when deciding initial antibiotic route and HM providers ranked features on importance when transitioning to oral antibiotics. Responses were grouped as not important (1–3), neutral (4–6), and important (7–9) and re-evaluated in the second round to reach consensus, defined as ≥70% agreement. Results Emergency medicine providers (n = 17) reached consensus on 15 of 16 features (93.8%), 10 deemed important. Participants reached greatest consensus (100%) on fevers/chills, lymphangitis, and functional impairment as considerations for initiating intravenous antibiotics. HM providers (n = 15) reached consensus on 9 of 11 factors (81.8%), with 7 considered important when deciding on readiness for oral antibiotics. Providers indicated that stability, rather than reduction, of erythematous margins is sufficient to consider transition and de-escalation of therapy at less than 24 hours if all other clinical improvement criteria are met. Conclusions This study achieved consensus on important features for treatment and disposition of children with uncomplicated cellulitis in both emergency and inpatient contexts. These features have the potential to aid in decision making and improve standardization of clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of Children With Uncomplicated Cellulitis in Emergency and Hospital Settings

St. Cyr,

Jaffe,

McMahon

et al. 2023

Pediatr Emer Care

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“…The duration of treatment is usually 5 to 7 days for patients with uncomplicated cellulitis who improve clinically early [70–72,73 ▪▪ ].…”

Section: Introductionmentioning

confidence: 99%

How to manage skin and soft-tissue infections in the emergency department

Bouza

Burillo

Muñóz

2023

Current Opinion in Infectious Diseases

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Purpose of reviewOur purpose is to review the state-of-the-art on the management of skin and soft tissue infections (SSTI) in emergency departments (ED).Although the information is scarce, SSTI may account for 3–30% of all cases presenting to an ED, of which 25–40% require hospital admission.SSTI include very different entities in aetiology, location, pathogenesis, extension, and severity. Therefore, no single management can be applied to them all. A simple approach is to classify them as non-purulent, purulent, and necrotising, to which a severity scale based on their systemic repercussions (mild, moderate, and severe) must be added.The initial approach to many SSTIs often requires no other means than anamnesis and physical examination, but imaging tests are an indispensable complement in many other circumstances (ultrasound, computerized tomography, magnetic resonance imaging…). In our opinion, an attempt at etiological filiation should be made in severe cases or where there is suspicion of a causality other than the usual one, with tests based not only on cultures of the local lesion but also molecular tests and blood cultures.Recent findingsRecent contributions of interest include the value of bedside ultrasound and the potential usefulness of biomarkers such as thrombomodulin to differentiate in early stages the presence of necrotising lesions not yet explicit.New antimicrobials will allow the treatment of many of these infections, including severe ones, with oral drugs with good bioavailability and for shorter periods.SummaryThe ED has an essential role in managing SSTIs, in their classification, in decisions on when and where to administer antimicrobial treatment, and in the rapid convening of multidisciplinary teams that can deal with the most complex situations.

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“…It also provides an avenue to treat oral antibiotic “treatment failures” without admission. However, the literature does not currently justify parenteral therapy in treating stable SSSI 2,3 . Furthermore, a potential downside is that the cost of the novel antibiotic selected for use in this study, $4,604 per 1500 mg of dalbavancin, may be very limiting for hospitals and patients alike.…”

mentioning

confidence: 96%

“…Once diagnosed with an SSSI the physician can choose between a number of treatments including discharge with oral antibiotics, a single dose of IV antibiotics followed by discharge on oral meds, or just admission for IV therapy. Current literature suggests that these options are noninferior to each other for patients not in shock and without suspicion for necrotizing infections 2 . Still, many physicians choose parenteral therapy for various reasons, including the reasoning that it simply feels safer 3 .…”

mentioning

confidence: 99%

Clinical pathways linking antibiotics to follow‐up care can reduce hospital admissions

Mycyk

2021

Academic Emergency Medicine

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Route and duration of antibiotic therapy in acute cellulitis: A systematic review and meta-analysis of the effectiveness and harms of antibiotic treatment

Abstract: J (2020) Route and duration of antibiotic therapy in acute cellulitis: a systematic review and meta-analysis of the effectiveness and harms of antibiotic treatment.

Cited by 16 publications

References 70 publications

Management of Children With Uncomplicated Cellulitis in Emergency and Hospital Settings

Management of Children With Uncomplicated Cellulitis in Emergency and Hospital Settings

How to manage skin and soft-tissue infections in the emergency department

Clinical pathways linking antibiotics to follow‐up care can reduce hospital admissions

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