Flucloxacillin alone or combined with benzylpenicillin to treat lower limb
cellulitis: a randomised controlled trial.
Author(s): Leman P, Mukherjee D.
Affiliation(s): Emergency Department, St Thomas' Hospital, London, UK.
peter.leman@health.wa.gov.au
Publication date & source: 2005, Emerg Med J. , 22(5):342-6
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 degrees 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.
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