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High-dose cephalexin for cellulitis: a pilot randomized controlled trial

BACKGROUND: Up to 3% of all Emergency Department (ED) visits are due to skin and soft tissue infections such as non-purulent cellulitis. The current treatment failure rate is approximately 20%. Evidence is lacking regarding the optimal outpatient management of cellulitis. OBJECTIVES: To evaluate the...

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Autores principales: Yadav, Krishan, Eagles, Debra, Perry, Jeffrey J., Taljaard, Monica, Sandino-Gold, Gabriel, Nemnom, Marie-Joe, Corrales-Medina, Vicente, Suh, Kathryn N., Stiell, Ian G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9807092/
https://www.ncbi.nlm.nih.gov/pubmed/36592299
http://dx.doi.org/10.1007/s43678-022-00433-7
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author Yadav, Krishan
Eagles, Debra
Perry, Jeffrey J.
Taljaard, Monica
Sandino-Gold, Gabriel
Nemnom, Marie-Joe
Corrales-Medina, Vicente
Suh, Kathryn N.
Stiell, Ian G.
author_facet Yadav, Krishan
Eagles, Debra
Perry, Jeffrey J.
Taljaard, Monica
Sandino-Gold, Gabriel
Nemnom, Marie-Joe
Corrales-Medina, Vicente
Suh, Kathryn N.
Stiell, Ian G.
author_sort Yadav, Krishan
collection PubMed
description BACKGROUND: Up to 3% of all Emergency Department (ED) visits are due to skin and soft tissue infections such as non-purulent cellulitis. The current treatment failure rate is approximately 20%. Evidence is lacking regarding the optimal outpatient management of cellulitis. OBJECTIVES: To evaluate the feasibility of a randomized trial comparing high-dose (1000 mg) to standard-dose (500 mg) cephalexin to treat ED patients with cellulitis. METHODS: A parallel arm double-blind randomized controlled pilot trial conducted at two EDs in Canada. Eligible participants were adults (age ≥ 18 years) presenting to the ED with non-purulent cellulitis and determined by the treating emergency physician to be eligible for outpatient management with oral antibiotics. Participants were randomized to high-dose or standard-dose cephalexin four times daily for 7 days. The primary feasibility outcome was participant recruitment rate (target ≥ 35%). The preliminary primary effectiveness outcome was oral antibiotic treatment failure. RESULTS: Of 134 eligible participants approached for trial participation, 69 (51.5%, 95% CI 43.1 to 59.8%) were recruited and randomized. After excluding three randomized participants due to an alternate diagnosis, 33 participants were included in each arm. Nineteen eligible cases (14.2%) were missed. Loss to follow-up was 6.1%. Treatment failure occurred in four patients (12.9%) in the standard-dose arm versus one patient (3.2%) in the high-dose arm. A greater proportion had minor adverse events in the high-dose arm. No patients had an unplanned hospitalization within 14 days. CONCLUSION: This pilot randomized controlled trial comparing high-dose to standard-dose cephalexin for ED patients with cellulitis demonstrated a high participant recruitment rate and that a full-scale trial is feasible. High-dose cephalexin had fewer treatment failures but with a higher proportion of minor adverse effects. The findings of this pilot will be used to inform the design of a future large trial. TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov (NCT04471246). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43678-022-00433-7.
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spelling pubmed-98070922023-01-04 High-dose cephalexin for cellulitis: a pilot randomized controlled trial Yadav, Krishan Eagles, Debra Perry, Jeffrey J. Taljaard, Monica Sandino-Gold, Gabriel Nemnom, Marie-Joe Corrales-Medina, Vicente Suh, Kathryn N. Stiell, Ian G. CJEM Original Research BACKGROUND: Up to 3% of all Emergency Department (ED) visits are due to skin and soft tissue infections such as non-purulent cellulitis. The current treatment failure rate is approximately 20%. Evidence is lacking regarding the optimal outpatient management of cellulitis. OBJECTIVES: To evaluate the feasibility of a randomized trial comparing high-dose (1000 mg) to standard-dose (500 mg) cephalexin to treat ED patients with cellulitis. METHODS: A parallel arm double-blind randomized controlled pilot trial conducted at two EDs in Canada. Eligible participants were adults (age ≥ 18 years) presenting to the ED with non-purulent cellulitis and determined by the treating emergency physician to be eligible for outpatient management with oral antibiotics. Participants were randomized to high-dose or standard-dose cephalexin four times daily for 7 days. The primary feasibility outcome was participant recruitment rate (target ≥ 35%). The preliminary primary effectiveness outcome was oral antibiotic treatment failure. RESULTS: Of 134 eligible participants approached for trial participation, 69 (51.5%, 95% CI 43.1 to 59.8%) were recruited and randomized. After excluding three randomized participants due to an alternate diagnosis, 33 participants were included in each arm. Nineteen eligible cases (14.2%) were missed. Loss to follow-up was 6.1%. Treatment failure occurred in four patients (12.9%) in the standard-dose arm versus one patient (3.2%) in the high-dose arm. A greater proportion had minor adverse events in the high-dose arm. No patients had an unplanned hospitalization within 14 days. CONCLUSION: This pilot randomized controlled trial comparing high-dose to standard-dose cephalexin for ED patients with cellulitis demonstrated a high participant recruitment rate and that a full-scale trial is feasible. High-dose cephalexin had fewer treatment failures but with a higher proportion of minor adverse effects. The findings of this pilot will be used to inform the design of a future large trial. TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov (NCT04471246). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43678-022-00433-7. Springer International Publishing 2023-01-02 2023 /pmc/articles/PMC9807092/ /pubmed/36592299 http://dx.doi.org/10.1007/s43678-022-00433-7 Text en © The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU) 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Research
Yadav, Krishan
Eagles, Debra
Perry, Jeffrey J.
Taljaard, Monica
Sandino-Gold, Gabriel
Nemnom, Marie-Joe
Corrales-Medina, Vicente
Suh, Kathryn N.
Stiell, Ian G.
High-dose cephalexin for cellulitis: a pilot randomized controlled trial
title High-dose cephalexin for cellulitis: a pilot randomized controlled trial
title_full High-dose cephalexin for cellulitis: a pilot randomized controlled trial
title_fullStr High-dose cephalexin for cellulitis: a pilot randomized controlled trial
title_full_unstemmed High-dose cephalexin for cellulitis: a pilot randomized controlled trial
title_short High-dose cephalexin for cellulitis: a pilot randomized controlled trial
title_sort high-dose cephalexin for cellulitis: a pilot randomized controlled trial
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9807092/
https://www.ncbi.nlm.nih.gov/pubmed/36592299
http://dx.doi.org/10.1007/s43678-022-00433-7
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