Long-term antimicrobial therapy in the prevention of recurrent soft-tissue infections

doi:10.1016/0163-4453(91)90898-3

Journal of Infection

Volume 22, Issue 1, January 1991, Pages 37-40

https://doi.org/10.1016/0163-4453(91)90898-3 Get rights and content

Summary

Thirty-six patients who had suffered two or more episodes of erysipelas or cellulitis during the previous year were randomly divided into two equal groups; one group received erythromycin base 250 mg b.i.d. for 18 months, while the other group received no prophylaxis for a similar period.

No patients in the treated group developed infection during the 18 months' followup but eight of the control group (50 %) relapsed and required antibiotic treatment.

Prolonged antimicrobial prophylaxis is effective and safe in preventing recurrent episodes of soft-tissue infections.

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There are more references available in the full text version of this article.

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Top 10 Myths Regarding the Diagnosis and Treatment of Cellulitis
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Lesson 9: Antibiotic prophylaxis has been shown to be effective in suppressing infection and decreasing rates of recurrence, but recurrence may occur despite adherence to therapy. Treatment of causes of infection and optimization of treatment of other disease states may decrease the risk of recurrence (50–52). A study of 398 cases compared to 8005 controls discovered 40% of patients experienced cellulitis recurrence despite prophylactic treatment with benzathine penicillin.
Cellulitis is commonly treated in the emergency department (ED). Patients who present with cellulitis incur significant health care costs and may be overtreated with antibiotics. The accurate diagnosis and treatment of cellulitis plays an important role in cost-effective, high-quality medical care, as well as appropriate antibiotic utilization.
We aim to describe common fallacies regarding cellulitis. We present 10 myths that result in misdiagnosis, overtreatment, or inappropriate empiric management of cellulitis. Clinical presentation, including swelling and redness, is explored in depth, along with incidence of community-acquired methicillin-resistance Staphylococcus aureus, management of tick bites, and effective antibiotic therapy for cellulitis.
Patients are often treated for cellulitis unnecessarily or inappropriately. Awareness of these myths will help guide providers in clinical decision making in order to effectively tailor treatment for these infections.
Cellulitis is not as simple as it might seem, and is commonly misdiagnosed in the ED. Noninfectious causes of local symptoms, including lymphedema, venous stasis, and deep vein thrombosis need to be considered. Cellulitis should be treated with empiric antimicrobial therapy based on patient risk factors and regional susceptibility patterns. This review will assist providers in managing cellulitis and avoiding treatment errors that lead to high costs, unwanted side effects for patients, and overuse of antibiotics.
Streptococcus pyogenes
2014, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases
Antibiotic prophylaxis for preventing recurrent cellulitis: A systematic review and meta-analysis
2014, Journal of Infection
Citation Excerpt :
Sjoblom 1993 reported that 2/20 (10%) intervention group patients and 8/20 (40%) comparison group patients had recurrences after up to a maximum of approximately 3 years of follow-up.23 The primary outcome of the number of episodes per patient reported in Kremer 1991 was that 7/16 (44%) patients had 1 recurrence of cellulitis, and that 1/16 (6%) patients had 2 relapses of cellulitis in the comparison group (there were no recurrences of cellulitis in the intervention group).22 PATCH II reported that there were 3 patients with 2 recurrences, 2 patients with 3 recurrences, 2 patients with 4 recurrences, and 1 patient with 7 recurrences.
A significant proportion of patients who have had a first episode of erysipelas or uncomplicated cellulitis will subsequently develop a recurrence. There is disagreement about how effective antibiotic prophylaxis is for preventing recurrent cellulitis.
To determine if antibiotic prophylaxis is effective in preventing recurrent cellulitis compared to no prophylaxis using a systematic review and meta-analysis.
Studies in any language identified by searching Medline, EMBASE, Cochrane Library, CINAHL, TRIP database, clinical practice guidelines websites, and ongoing trials databases up to 31st August 2012. Search terms included cellulitis, erysipelas, controlled clinical trial, randomized, placebo, clinical trials, randomly, and trial.
Only controlled trials comparing antibiotic prophylaxis to no antibiotic prophylaxis in patients age 16 years and above, and after 1 or more episodes of cellulitis, were included.
Independent extraction of articles was done by 2 investigators using predefined data extraction templates, including study quality indicators. PROSPERO registration number: CRD42012002528. Meta-analyses were done using random-effects models.
The primary outcome was the number of patients with a recurrence of cellulitis. Secondary outcomes were (1) the time to next episode of recurrence, (2) quality of life measures, and (3) adverse events (e.g. allergic reactions, nausea).
Five randomized controlled trials (n = 535), with 260 patients in the intervention arm and 275 in the comparator group met our inclusion criteria. 44 patients (8%) in the antibiotic prophylaxis group and 97 patients (18%) in the comparator group had an episode of cellulitis. Antibiotic prophylaxis significantly reduced the number of patients having recurrent cellulitis, with a risk ratio (RR) of 0.46 (95% CI 0.26–0.79). None of the studies reported severe adverse effects to antibiotics. There was methodological heterogeneity amongst the studies in terms of types of antibiotic used, delivery modes, number of recurrences of cellulitis at study entry, and study quality.
Antibiotic prophylaxis can prevent recurrent cellulitis. Future research should aim to identify the ideal type, dosage, and duration of antibiotics for prophylaxis, as well as to identify the group of patients who will benefit most from antibiotic prophylaxis.
Review of streptococcal bloodstream infections at a comprehensive cancer care center, 2000-2011
2013, Journal of Infection
To determine the comparative rates, clinical characteristics, and outcomes of invasive infections due to specific streptococcal types in patients with cancer.
Review of electronic medical records of patients with non-viridans group streptococcal bloodstream infection (BSI) at the MD Anderson Cancer Center from 2000 to 2011.
550 streptococcal BSI were identified. The largest number of cases were caused by Streptococcus pneumoniae (251), group B Streptococcus (147), and gamma-hemolytic streptococci (55). Risk factors for developing a severe streptococcal infection included older age, being neutropenic at onset of BSI, and having a respiratory source of infection. Between 2000–2001 and 2010–2011, the rates of S. pneumoniae BSI and penicillin non-susceptibility decreased by 55% and 100%. In contrast the rate of group B streptococcal (GBS) BSI increased 34% over the same time period. GBS accounted for >80% of the recurrent infections following streptococcal BSI. Patients with breast cancer and those with soft-tissue/bone BSI sources were at increased risk for recurrent GBS infection but had lower rates of severe GBS disease.
From 2000 to 2011, our comprehensive cancer center observed a significant decrease in the rates of S. pneumoniae BSI and a significant increase in the rates of GBS BSI.
A 60-year-old woman with recurrent cellulitis
2019, CMAJ
Citation Excerpt :
Chronic antimicrobial prophylaxis is an additional strategy that may be appropriate for certain patients with recurrent cellulitis. The efficacy of antimicrobial prophylaxis in preventing recurrent cellulitis is supported by results from 3 RCTs.6–8 The largest and most recent RCT showed that in individuals with 2 or more episodes in a 3-year period, chronic therapy with oral penicillin V potassium delayed time to recurrence by 94 days, and reduced risk of recurrence by 45% while on treatment.7

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Original articleLong-term antimicrobial therapy in the prevention of recurrent soft-tissue infections

Summary

The nature of an infectious disease practice in a community hospital

Rev Infect Dis

Skin and soft tissue infections

Changing therapy for skin and soft tissue infections in children: have we come full circle?

Pediatr Infect Dis J

Original article
Long-term antimicrobial therapy in the prevention of recurrent soft-tissue infections