Recurrent Cellulitis: Robust Information From an RCT
Recurrent Cellulitis: Robust Information From an RCT
Hello. This is Paul Auwaerter for Medscape Infectious Diseases and from the Johns Hopkins University School of Medicine, Division of Infectious Diseases.
Recurrent cellulitis can be a vexing problem and not an uncommon cause for infectious diseases consultation. Patients often have open wounds, maceration around the toes, fungal infections in their toenails, or chronic swelling in their legs that may predispose them to developing cellulitis. As infectious diseases physicians, we may have a litany of recommendations, including leg elevation, wearing compression hosiery, decongestive therapy from the occupational therapist to reduce lymphedema, and even antifungal strategies to help eradicate fungus from toenails.
For patients who have recurrent cellulitis, we also have often suggested long-term oral antibiotic therapy, with precious little evidence to go on. In fact, we have only 3 small studies from the early 1990s. For example, the first of these looked at around 30 patients who were randomly assigned to receive erythromycin or placebo. The authors in that case concluded that erythromycin helped to prevent cellulitis. Cellulitis is probably almost always caused by streptococci, usually group A. But over the years, macrolide resistance among streptococci has increased, so that strategy may not be effective anymore.
Therefore, I want to applaud Thomas and colleagues, who have put together an extraordinary clinical trial from the United Kingdom, and to thank them, the sponsoring UK research grant agency, and the New England Journal of Medicine for publishing what I think is an important randomized clinical trial (RCT), the kind that is all too rare in areas where many of us rely on much smaller amounts of data to help guide clinical decision-making.
Hello. This is Paul Auwaerter for Medscape Infectious Diseases and from the Johns Hopkins University School of Medicine, Division of Infectious Diseases.
Recurrent cellulitis can be a vexing problem and not an uncommon cause for infectious diseases consultation. Patients often have open wounds, maceration around the toes, fungal infections in their toenails, or chronic swelling in their legs that may predispose them to developing cellulitis. As infectious diseases physicians, we may have a litany of recommendations, including leg elevation, wearing compression hosiery, decongestive therapy from the occupational therapist to reduce lymphedema, and even antifungal strategies to help eradicate fungus from toenails.
For patients who have recurrent cellulitis, we also have often suggested long-term oral antibiotic therapy, with precious little evidence to go on. In fact, we have only 3 small studies from the early 1990s. For example, the first of these looked at around 30 patients who were randomly assigned to receive erythromycin or placebo. The authors in that case concluded that erythromycin helped to prevent cellulitis. Cellulitis is probably almost always caused by streptococci, usually group A. But over the years, macrolide resistance among streptococci has increased, so that strategy may not be effective anymore.
Therefore, I want to applaud Thomas and colleagues, who have put together an extraordinary clinical trial from the United Kingdom, and to thank them, the sponsoring UK research grant agency, and the New England Journal of Medicine for publishing what I think is an important randomized clinical trial (RCT), the kind that is all too rare in areas where many of us rely on much smaller amounts of data to help guide clinical decision-making.
