For the practicing clinicians reading this blog, here is an article published in Clinical Infectious Diseases that gives us much needed data to guide our choice of antibiotics.Cellutis without the presence of pus, which is the vast majority of cases, is typically streptococcal and not staphylococcal.Despite this, antibiotics targeting community associated MRSA (CA-MRSA) are prescribed commonly. But what is it needed?
The investigators performed a randomized, multicenter, double-blind, placebo-controlled trial from 2007 to 2011. Patients enrolled had cellulitis, no abscesses, symptoms for <1 week, and no diabetes, immunosuppression, peripheral vascular disease, or hospitalization. All participants received cephalexin. Additionally, and was randomized to trimethoprim-sulfamethoxazole or placebo for a total of 14 days.
For those receiving cephalexin and trimethoprim-sulfamethoxazole, 62/73 (85%) were cured versus 60/73 controls (82%), a risk difference of 2.7% (95% confidence interval, -9.3% to 15%; P = .66).
Finally, we have some quality data to suggest that for the management of puss-less cellulitis, in an outpatient setting, there is no need to add an additional antibiotic to cover CA-MRSA.
More is not always better!
