Daptomycin-Based 3 Week Treatment Scheme for the First Cellulitis Episode: Low Recurrence Rate Indicative of Decreased Recurrence Propensity?

INTRODUCTION: Cellulitis recurrences are frequent, difficult to manage, and contribute considerably to overall disease burden. This retrospective cases series reports recurrence rates of first community-acquired lower limb disease episode initially treated with daptomycin. METHODS: Treatment consisted of a 21-day two substances sequential scheme: intravenous daptomycin (4 mg/kg/day) during hospitalization and roxithromycin (2 × 150 mg per os) afterwards. Primary study end-point was the rate of recurrences during follow-up; recurrence rates and their binomial 95% confidence intervals (CI) were calculated with SPSS 22.0. Recurrences were identified by (1) review of hospital records and (2) telephone questionnaires. RESULTS: Twenty-seven patients hospitalized for first lower limb cellulitis episodes were started on daptomycin and 26 patients completed the above three-week sequential treatment scheme. During follow-up (range 37–85 months) one recurrence occurred among the 26 patients who completed the treatment: 96.2% of these patients remained relapse free at the end of follow-up (CI 79.5–99.9%). Considering also treatment failure, the overall effectiveness of this combination treatment was 92.6% recurrence free after more than 3 years follow-up (25/27 patients; CI 75.5–99.0%). This study is limited by retrospective planning and the restricted number of included patients. CONCLUSION: The choice of the treatment for the initial lower limb cellulitis episode may impact the risk of disease recurrences. Future studies should explore interventions for the first cellulitis episode as a means to modify the risk of the recurring course of this disease. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13555-016-0095-8) contains supplementary material, which is available to authorized users.