HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Leman, P Articles by Mukherjee, D Search for Related Content PubMed PubMed Citation Articles by Leman, P Articles by Mukherjee, D

Flucloxacillin alone or combined with benzylpenicillin to treat lower limb cellulitis: a randomised controlled trial

Emergency Department, St Thomas’ Hospital, London, UK

Correspondence to:
Correspondence to:
Dr P Leman
Emergency Department, Royal Perth Hospital, Wellington Street, Perth, WA 6001, Australia; peter.leman{at}health.wa.gov.au

Objective: To determine whether using intravenous benzylpenicillin in addition to intravenous flucloxacillin would result in a more rapid clinical response in patients with lower limb cellulitis.

Methods: This was a randomised controlled trial set in an inner city teaching hospital, comprising 81 patients with lower limb cellulitis requiring intravenous antibiotics. The main outcome measure was the mean number of doses of antibiotic required until clinical response.

Results: The mean number of doses required was 8.47 (95% confidence interval (CI) 7.09 to 9.86) in the benzylpenicillin and flucloxacillin combined group. In the flucloxacillin only group it was 8.71 doses (95% CI 6.90 to 10.5), a mean difference of –0.24 doses (95% CI –2.48 to 2.01, p = 0.83). Other markers of treatment efficacy showed no difference between groups at review the following day; temperature decrease (mean difference –0.07°C, 95% CI –0.76 to 0.62, p = 0.84), or diameter decrease of affected area (mean difference –34 mm, 95% CI –99 to 31, p = 0.30). Patient subjective assessments were also similar between the different drug regimen; improvement on a visual analogue scale of pain/discomfort from admission to first review (mean difference 10 mm, 95% CI –12.6 to 14.2, p = 0.91) and on second review (mean difference 15 mm, 95% CI –18.6 to 21.6, p = 0.88). Patient overall subjective feelings of improvement on first review (p = 0.32) and on second review (p = 0.64) were also similar.

Conclusions: This study provides no evidence to support the addition of intravenous benzylpenicillin to intravenous flucloxacillin in the treatment of lower limb cellulitis.

Abbreviations: ED, emergency department; VAS, visual analogue scale

Keywords: antibiotic therapy; cellulitis; observation medicine