Treating cellulitis: meta-analysis hampered by low-quality evidence

  • Brindle R & al.
  • JAMA Dermatol
  • 12/06/2019

  • Brian Richardson, PhD
  • Clinical Essentials
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Takeaway

  • A systematic review and meta-analysis failed to determine the most effective treatment for cellulitis, citing low-quality evidence.

Why this matters

  • The optimal antibiotic treatment for cellulitis is unclear.

Key results

  • Cellulitis was the primary diagnosis in 35% of included studies.
  • No evidence supported a specific antibiotic as most effective:
    • Penicillin vs cephalosporins: risk ratio (RR), 0.98; 95% CI, 0.68-1.42.
    • Cephalosporin A vs cephalosporin B: RR, 1.02; 95% CI, 0.96-1.09.
    • β-lactam vs macrolide, lincosamide, or streptogramin: RR, 0.94; 95% CI, 0.85-1.04.
    • Quinolone or vancomycin vs other antibiotic: RR, 1.04; 95% CI, 0.94-1.16.
    • Linezolid vs other antibiotic: RR, 1.00; 95% CI, 0.95-1.05.
    • Clindamycin vs trimethoprim sulfamethoxazole: RR, 1.05; 95% CI, 0.96-1.15.
  • Antibiotics with activity against methicillin-resistant Staphylococcus aureus did not add to effectiveness (RR, 0.99; 95% CI, 0.92-1.06).
  • Intravenous antibodies were inferior to oral antibiotics (RR, 0.83; P<.001 low-quality evidence>
  • Longer treatment duration did not improve effectiveness (RR, 0.99; 95% CI, 0.94-1.04).

Study design

  • 43 studies (5999 participants) were included in the meta-analysis.
  • The primary outcome was the proportion of patients cured, improved, symptom-free, or symptom-reduced after treatment.
  • Funding: None disclosed.

Limitations

  • Most included studies lacked clear endpoints.