Skip to main content
NCBI home page
Emergency Medicine Journal : EMJ logoLink to Emergency Medicine Journal : EMJ
. 2005 May;22(5):342–346. doi: 10.1136/emj.2004.019869

Flucloxacillin alone or combined with benzylpenicillin to treat lower limb cellulitis: a randomised controlled trial

P Leman 1, D Mukherjee 1
PMCID: PMC1726763  PMID: 15843702

Abstract

Objective: To determine whether using intravenous benzylpenicillin in addition to intravenous flucloxacillin would result in a more rapid clinical response in patients with lower limb cellulitis.

Methods: This was a randomised controlled trial set in an inner city teaching hospital, comprising 81 patients with lower limb cellulitis requiring intravenous antibiotics. The main outcome measure was the mean number of doses of antibiotic required until clinical response.

Results: The mean number of doses required was 8.47 (95% confidence interval (CI) 7.09 to 9.86) in the benzylpenicillin and flucloxacillin combined group. In the flucloxacillin only group it was 8.71 doses (95% CI 6.90 to 10.5), a mean difference of –0.24 doses (95% CI –2.48 to 2.01, p = 0.83). Other markers of treatment efficacy showed no difference between groups at review the following day; temperature decrease (mean difference –0.07°C, 95% CI –0.76 to 0.62, p = 0.84), or diameter decrease of affected area (mean difference –34 mm, 95% CI –99 to 31, p = 0.30). Patient subjective assessments were also similar between the different drug regimen; improvement on a visual analogue scale of pain/discomfort from admission to first review (mean difference 10 mm, 95% CI –12.6 to 14.2, p = 0.91) and on second review (mean difference 15 mm, 95% CI –18.6 to 21.6, p = 0.88). Patient overall subjective feelings of improvement on first review (p = 0.32) and on second review (p = 0.64) were also similar.

Conclusions: This study provides no evidence to support the addition of intravenous benzylpenicillin to intravenous flucloxacillin in the treatment of lower limb cellulitis.

Full Text

The Full Text of this article is available as a PDF (70.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aly A. A., Roberts N. M., Seipol K. S., MacLellan D. G. Case survey of management of cellulitis in a tertiary teaching hospital. Med J Aust. 1996 Nov 18;165(10):553–556. doi: 10.5694/j.1326-5377.1996.tb138641.x. [DOI] [PubMed] [Google Scholar]
  2. Bernard Philippe, Chosidow Olivier, Vaillant Loïc, French Erysipelas Study Group Oral pristinamycin versus standard penicillin regimen to treat erysipelas in adults: randomised, non-inferiority, open trial. BMJ. 2002 Oct 19;325(7369):864–864. doi: 10.1136/bmj.325.7369.864. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bucko Alicia D., Hunt Barbara J., Kidd Sarah L., Hom Richard. Randomized, double-blind, multicenter comparison of oral cefditoren 200 or 400 mg BID with either cefuroxime 250 mg BID or cefadroxil 500 mg BID for the treatment of uncomplicated skin and skin-structure infections. Clin Ther. 2002 Jul;24(7):1134–1147. doi: 10.1016/s0149-2918(02)80024-8. [DOI] [PubMed] [Google Scholar]
  4. Cox Neil H. Management of lower leg cellulitis. Clin Med (Lond) 2002 Jan-Feb;2(1):23–27. doi: 10.7861/clinmedicine.2-1-23. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dong S. L., Kelly K. D., Oland R. C., Holroyd B. R., Rowe B. H. ED management of cellulitis: a review of five urban centers. Am J Emerg Med. 2001 Nov;19(7):535–540. doi: 10.1053/ajem.2001.28330. [DOI] [PubMed] [Google Scholar]
  6. Dupuy A., Benchikhi H., Roujeau J. C., Bernard P., Vaillant L., Chosidow O., Sassolas B., Guillaume J. C., Grob J. J., Bastuji-Garin S. Risk factors for erysipelas of the leg (cellulitis): case-control study. BMJ. 1999 Jun 12;318(7198):1591–1594. doi: 10.1136/bmj.318.7198.1591. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Eriksson B., Jorup-Rönström C., Karkkonen K., Sjöblom A. C., Holm S. E. Erysipelas: clinical and bacteriologic spectrum and serological aspects. Clin Infect Dis. 1996 Nov;23(5):1091–1098. doi: 10.1093/clinids/23.5.1091. [DOI] [PubMed] [Google Scholar]
  8. Gach J. E., Charles-Holmes R., Ghose A. E. coli cellulitis. Clin Exp Dermatol. 2002 Sep;27(6):523–525. doi: 10.1046/j.1365-2230.2002.10642.x. [DOI] [PubMed] [Google Scholar]
  9. Gentry L. O., Rodriguez-Gomez G., Zeluff B. J., Khoshdel A., Price M. A comparative evaluation of oral ofloxacin versus intravenous cefotaxime therapy for serious skin and skin structure infections. Am J Med. 1989 Dec 29;87(6C):57S–60S. [PubMed] [Google Scholar]
  10. Grayson M. L., Silvers J., Turnidge J. Home intravenous antibiotic therapy. A safe and effective alternative to inpatient care. Med J Aust. 1995 Mar 6;162(5):249–253. [PubMed] [Google Scholar]
  11. Grayson M. Lindsay, McDonald Malcolm, Gibson Kimberley, Athan Eugene, Munckhof Wendy J., Paull Phillip, Chambers Fran. Once-daily intravenous cefazolin plus oral probenecid is equivalent to once-daily intravenous ceftriaxone plus oral placebo for the treatment of moderate-to-severe cellulitis in adults. Clin Infect Dis. 2002 May 7;34(11):1440–1448. doi: 10.1086/340056. [DOI] [PubMed] [Google Scholar]
  12. Hepburn Matthew J., Dooley David P., Ellis Michael W. Alternative diagnoses that often mimic cellulitis. Am Fam Physician. 2003 Jun 15;67(12):2471–2471. [PubMed] [Google Scholar]
  13. Howden B. P., Richards M. J. The efficacy of continuous infusion flucloxacillin in home therapy for serious staphylococcal infections and cellulitis. J Antimicrob Chemother. 2001 Aug;48(2):311–314. doi: 10.1093/jac/48.2.311. [DOI] [PubMed] [Google Scholar]
  14. Kiani R. Double-blind, double-dummy comparison of azithromycin and cephalexin in the treatment of skin and skin structure infections. Eur J Clin Microbiol Infect Dis. 1991 Oct;10(10):880–884. doi: 10.1007/BF01975848. [DOI] [PubMed] [Google Scholar]
  15. Leder K., Turnidge J. D., Grayson M. L. Home-based treatment of cellulitis with twice-daily cefazolin. Med J Aust. 1998 Nov 16;169(10):519–522. doi: 10.5694/j.1326-5377.1998.tb123398.x. [DOI] [PubMed] [Google Scholar]
  16. Lee N. H., Choi E. H., Lee W. S., Ahn S. K. Tuberculous cellulitis. Clin Exp Dermatol. 2000 May;25(3):222–223. doi: 10.1046/j.1365-2230.2000.00621.x. [DOI] [PubMed] [Google Scholar]
  17. Morris Andrew. Cellulitis and erysipelas. Clin Evid. 2002 Jun;(7):1483–1487. [PubMed] [Google Scholar]
  18. Morris Andrew. Cellulitis and erysipelas. Clin Evid. 2003 Jun;(9):1804–1809. [PubMed] [Google Scholar]
  19. Perl B., Gottehrer N. P., Raveh D., Schlesinger Y., Rudensky B., Yinnon A. M. Cost-effectiveness of blood cultures for adult patients with cellulitis. Clin Infect Dis. 1999 Dec;29(6):1483–1488. doi: 10.1086/313525. [DOI] [PubMed] [Google Scholar]
  20. Quartey-Papafio C. M. Lesson of the week: importance of distinguishing between cellulitis and varicose eczema of the leg. BMJ. 1999 Jun 19;318(7199):1672–1673. doi: 10.1136/bmj.318.7199.1672. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Ramirez-Ronda C. H., Saavedra S., Rivera-Vázquez C. R. Comparative, double-blind study of oral ciprofloxacin and intravenous cefotaxime in skin and skin structure infections. Am J Med. 1987 Apr 27;82(4A):220–223. [PubMed] [Google Scholar]
  22. Rolinson G. N., Sutherland R. Semisynthetic penicillins. Adv Pharmacol Chemother. 1973;11:151–220. doi: 10.1016/s1054-3589(08)60458-5. [DOI] [PubMed] [Google Scholar]
  23. Siami G., Christou N., Eiseman I., Tack K. J., Severe Skin and Soft Tissue Infections Study Group Clinafloxacin versus piperacillin-tazobactam in treatment of patients with severe skin and soft tissue infections. Antimicrob Agents Chemother. 2001 Feb;45(2):525–531. doi: 10.1128/AAC.45.2.525-531.2001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Sutherland R., Croydon E. A., Rolinson G. N. Flucloxacillin, a new isoxazolyl penicillin, compared with oxacillin, cloxacillin, and dicloxacillin. Br Med J. 1970 Nov 21;4(5733):455–460. doi: 10.1136/bmj.4.5733.455. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Vaillant L. Critères diagnostiques de l'érysipèle. Ann Dermatol Venereol. 2001 Mar;128(3 Pt 2):326–333. [PubMed] [Google Scholar]

Articles from Emergency Medicine Journal : EMJ are provided here courtesy of BMJ Publishing Group

RESOURCES