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Ongoing Antibiotic Prophylaxis Helps Prevent Cellulitis Recurrence

July 27, 2017

By Reuters Staff

NEW YORK (Reuters Health) – Antibiotic prophylaxis for recurrent cellulitis is effective, until the antibiotics are stopped, according to a new Cochrane Review.

“The evidence is limited to people with at least two past episodes of leg cellulitis within a time frame of up to three years, and none of the studies investigated other common interventions such as lymphedema reduction methods or proper skin care,” Dr. Adam Dalal of Rabin Medical Center in Petah Tikvah, Israel, and colleagues write. “Larger, high-quality studies are warranted, including long-term follow-up and other prophylactic measures.”

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The findings were published online June 20 in the Cochrane Database of Systematic Reviews.

As many as half of people with cellulitis will have repeated episodes of the skin infection, and little information is available on how to prevent recurrence, Dr. Dalal and colleagues write. They reviewed six trials with a total of 573 participants. Four were of penicillin (n=481), one of erythromycin (n=32), and one of selenium. Treatment duration ranged from six to 18 months. The selenium trial assessed prevention of cellulitis of the arms, and the antibiotic trials included patients with cellulitis of the legs.

There was modest-quality evidence that antibiotics reduced the likelihood of recurrent cellulitis by 69%, and the number of infections by 50%, compared to placebo or no treatment. Side effects included diarrhea, nausea, rash and thrush. No serious adverse events occurred.

After prophylaxis was discontinued, patients no longer were protected against recurrent episodes; this evidence was of low certainty. Hospitalization rates were not significantly different for patients given antibiotics and those given placebo or no treatment.

The researchers conclude: “In terms of recurrence, and time to next episode, antibiotic is probably an effective preventive treatment for recurrent cellulitis of the lower limbs in those under prophylactic treatment, compared with placebo or no treatment.”

Dr. Dalal was not available for an interview by press time.


Cochrane Database Syst Rev 2017.

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