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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

journal contribution
posted on 2023-06-07, 07:38 authored by Elizabeth L A Cross, Harriet Jordan, Rebecca Godfrey, Igho J Onakpoya, Annalie Shears, Katy FidlerKaty Fidler, Timothy E A Peto, A Sarah Walker, Martin LlewelynMartin Llewelyn
Objectives Compared with guideline recommendations, antibiotic overuse is common in treating cellulitis. We conducted a systematic review and meta-analyses on antibiotic route and duration of treatment for cellulitis in adults and children. Methods We searched MEDLINE, EMBASE and trial registries from inception to Dec 11, 2019 for interventional and observational studies of antibiotic treatment for cellulitis. Exclusions included case series/reports, pre-septal/orbital cellulitis and non-English language articles. Random-effects meta-analyses were used to produce summary relative risk (RR) estimates for our primary outcome of clinical response. PROSPERO CRD42018100602. Results We included 47/8423 articles, incorporating data from eleven trials (1855 patients) in two meta-analyses. The overall risk of bias was moderate. Only two trials compared the same antibiotic agent in each group. We found no evidence of difference in clinical response rates for antibiotic route or duration (RR(oral:IV)=1.12, 95%CI 0.98–1.27, I 2=32% and RR(shorter:longer)=0.99, 95%CI 0•96–1.03, I 2?=?0%, respectively). Findings were consistent in observational studies. Follow-up data beyond 30 days were sparse. Conclusions The evidence base for antibiotic treatment decisions in cellulitis is flawed by biased comparisons, short follow-up and lack of data around harms of antibiotic overuse. Future research should focus on developing patient-tailored antibiotic prescribing for cellulitis to reduce unnecessary antibiotic use.

Funding

Patient tailored antibiotic therapy in acute cellulitis; G3217; NATIONAL INSTITUTE FOR HEALTH RESEARCH; NIHR300952

History

Publication status

  • Published

File Version

  • Accepted version

Journal

Journal of Infection

ISSN

0163-4453

Publisher

Elsevier

Issue

4

Volume

81

Page range

521-531

Department affiliated with

  • Global Health and Infection Publications

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2020-07-30

First Open Access (FOA) Date

2021-08-01

First Compliant Deposit (FCD) Date

2020-07-30

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