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No conclusive evidence found on optimum antibiotic treatment for cellulitis

Researchers were unable to identify the most effective antibiotic treatment for cellulitis, as no one antibiotic was superior over another based on available clinical trial data, according to researchers in JAMA Dermatology.

“Identifying the optimum duration of antibiotic therapy was not possible, with only one trial designed to look specifically at duration, but no supporting evidence was found for antibiotic therapy longer than 5 days,” Richard Brindle, DM, FRCP, department of clinical sciences at the University of Bristol, United Kingdom, and colleagues wrote.

Additionally, studies with combination therapy did not yield better outcomes.

The systematic review identified 43 studies with 5,999 participants, adults and children aged 1 month to 96 years, with a cellulitis diagnosis.

The majority of studies compared different antibiotics or treatment durations, and no studies compared antibiotics with placebos. The researchers could not analyze variations in antibiotic doses and outcomes because there was a wide range of antibiotics across the studies.

The studies comparing penicillin with cephalosporins had high levels of heterogeneity (RR = 0.98; 95% CI, 0.68-1.42).

In six studies of older vs. newer cephalosporins, no differences were found between the two treatments. One study reported data on adverse events, but it was not statistically significant.

The researchers also found no significant differences in treatment effect or adverse events in studies assessing beta-lactam vs. macrolide, lincosamide or streptogramin antibiotics, or in studies comparing quinolone or vancomycin vs. another antibiotic.

Additionally, no difference was observed between vancomycin alone or vancomycin combination vs. other antibiotics (RR = 0.99; 95% CI, 0.94-1.04).

In intravenous administration vs. oral antibiotics, the researchers found low-quality evidence that IV administration was inferior compared with oral administration (RR = 0.83; 95% CI, 0.75-0.93; P < .001).

Most studies lacked consistent and precise endpoints for cellulitis therapies, representing a study limitation.

“Trials need to have standardized criteria for severity scoring ... to allow the examination of treatment route, dosing and duration. A standardized set of outcomes needs to be established for these trials,” the study authors wrote. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.