Interventions for Cellulitis and Erysipelas

Summary

A Cochrane review [Abstract] 1 included 25 studies with a total of 2488 subjects with erysipelas or cellulitis. No two trials examined the same drugs. Macrolides/streptogramins were found to be more effective than penicillin antibiotics (RR 0.84, 95% CI 0.73 to 0.97). In 3 trials involving 419 people, 2 of these studies used oral macrolide against intravenous (iv) penicillin demonstrating that oral therapies can be more effective than iv therapies (RR 0.85, 95% CI 0.73 to 0.98).Three studies with a total of 88 people comparing a penicillin with a cephalosporin showed no difference in treatment effect (RR 0.99, 95% CI 0.68 to 1.43).Six trials which included 538 people that compared different generations of cephalosporin, showed no difference in treatment effect (RR 1.00, 95% CI 0.94 to1.06).

There was insufficient evidence to form conclusions for duration of antibiotic treatment or intramuscular versus intravenous route.

Clinical comments

Although macrolides were in this review somewhat more effective than penicillin antibiotics, the growing macrolide resistance of streptococci means that they are not suitable first-line treatment options for erysipelas or cellulitis.