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 L A, Jordan, Harriet, Godfrey, Rebecca, Onakpoya, Igho J, Shears, Annalie, Fidler, Katy, Peto, Timothy E A, Walker, A Sarah and Llewelyn, Martin 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. Journal of Infection, 81 (4). pp. 521-531. ISSN 0163-4453

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Abstract

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.

Item Type: Article
Keywords: Administration, Intravenous, Administration, Oral, Anti-bacterial agents, Cellulitis, Duration of therapy, Erysipelas, Soft tissue infections
Schools and Departments: Brighton and Sussex Medical School > Global Health and Infection
SWORD Depositor: Mx Elements Account
Depositing User: Mx Elements Account
Date Deposited: 30 Jul 2020 08:42
Last Modified: 23 Feb 2022 12:23
URI: http://sro.sussex.ac.uk/id/eprint/92838

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Project NameSussex Project NumberFunderFunder Ref
Patient tailored antibiotic therapy in acute cellulitisG3217NATIONAL INSTITUTE FOR HEALTH RESEARCHNIHR300952