Efficacy and safety of first- and second-line antibiotics for cellulitis and erysipelas: a network meta-analysis of randomized controlled trials.
Antibiotics
Cellulitis
Erysipelas
Journal
Archives of dermatological research
ISSN: 1432-069X
Titre abrégé: Arch Dermatol Res
Pays: Germany
ID NLM: 8000462
Informations de publication
Date de publication:
06 Sep 2024
06 Sep 2024
Historique:
received:
30
05
2024
accepted:
05
08
2024
revised:
15
07
2024
medline:
6
9
2024
pubmed:
6
9
2024
entrez:
6
9
2024
Statut:
epublish
Résumé
This study systematically evaluated and ranked the efficacy of first- and second-line antibiotics antibiotic options for the clinical management of cellulitis and erysipelas through a network meta-analysis approach. From inception to July 04, 2024, a search for relevant randomized clinical trials (RCTs) was carried out using several databases. Antibiotics including azithromycin, cefaclor, cephalexin, cloxacillin, erythromycin, cephalexin plus trimethoprim-sulfamethoxazole, cephalexin plus placebo, flucloxacillin, clindamycin, ceftriaxone, penicillin, roxithromycin, and pristinamycin were assessed regarding cure rate, the eradication of baseline pathogens, diarrhea or vomiting, and rash. In total, 10 RCTs with 1,936 cellulitis or erysipelas patients were eligible for inclusion. There were no significant differences in the cure rates for cellulitis among the antibiotics analysed, with cefaclor demonstrating the most favorable profile for curative outcomes. In terms of side effects, ceftriaxone was identified as the least likely to induce diarrhea or vomiting. For erysipelas, pristinamycin showed the most promising results in achieving cure rates. Although a comparison of the three antibiotics revealed no significant differences in rash as a side effect in erysipelas, pristinamycin was observed to carry the highest risk for rash. Our findings indicate no significant differences in cure rates among antibiotics for cellulitis. However, ceftriaxone had the fewest gastrointestinal side effects. Pristinamycin showed the highest cure rates for erysipelas but with a higher risk of rash. Future research should focus on optimizing antibiotic selection for cellulitis and erysipelas.
Identifiants
pubmed: 39240378
doi: 10.1007/s00403-024-03317-1
pii: 10.1007/s00403-024-03317-1
doi:
Substances chimiques
Anti-Bacterial Agents
0
Pristinamycin
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
603Informations de copyright
© 2024. The Author(s).
Références
Michael Y, Shaukat NM (2024) Erysipelas. In: StatPearls edn. Treasure Island (FL) ineligible companies. Disclosure: Nadia Shaukat declares no relevant financial relationships with ineligible companies.: StatPearls Publishing Copyright © 2024, StatPearls Publishing LLC
Bystritsky RJ (2021) Cellulitis. Infect Dis Clin N Am 35(1):49–60
doi: 10.1016/j.idc.2020.10.002
Brown BD, Hood Watson KL (2024) Cellulitis. In: StatPearls edn. Treasure Island (FL) ineligible companies. Disclosure: Kristen Hood Watson declares no relevant financial relationships with ineligible companies.: StatPearls Publishing Copyright © 2024, StatPearls Publishing LLC
Boettler MA, Kaffenberger BH, Chung CG (2022) Cellulitis: a review of current practice guidelines and differentiation from Pseudocellulitis. Am J Clin Dermatol 23(2):153–165
doi: 10.1007/s40257-021-00659-8
pubmed: 34902109
Cross ELA, Jordan H, Godfrey R, Onakpoya IJ, Shears A, Fidler K, Peto TEA, Walker AS, Llewelyn MJ (2020) Route and duration of antibiotic therapy in acute cellulitis: a systematic review and meta-analysis of the effectiveness and harms of antibiotic treatment. J Infect 81(4):521–531
doi: 10.1016/j.jinf.2020.07.030
pubmed: 32745638
Gunderson CG (2016) Overtreatment of nonpurulent cellulitis. J Hosp Med 11(8):587–590
doi: 10.1002/jhm.2593
pubmed: 27480889
Long B, Gottlieb M (2022) Diagnosis and management of Cellulitis and Abscess in the Emergency Department setting: an evidence-based review. J Emerg Med 62(1):16–27
doi: 10.1016/j.jemermed.2021.09.015
pubmed: 34657784
Ferreira A, Bolland MJ, Thomas MG (2016) Meta-analysis of randomised trials comparing a penicillin or cephalosporin with a macrolide or lincosamide in the treatment of cellulitis or erysipelas. Infection 44(5):607–615
doi: 10.1007/s15010-016-0895-x
pubmed: 27085865
Moran GJ, Krishnadasan A, Mower WR, Abrahamian FM, LoVecchio F, Steele MT, Rothman RE, Karras DJ, Hoagland R, Pettibone S et al (2017) Effect of Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin alone on clinical cure of uncomplicated cellulitis: a Randomized Clinical Trial. JAMA 317(20):2088–2096
doi: 10.1001/jama.2017.5653
pubmed: 28535235
pmcid: 5815038
Weesner E, Ghassemi H, Salapenka I, Konakanchi JS, Maggio G, Sethi R (2022) Injection site reaction to extended-release buprenorphine (Sublocade(
doi: 10.17161/kjm.vol15.17931
pubmed: 36042837
pmcid: 9409986
Pallin DJ, Binder WD, Allen MB, Lederman M, Parmar S, Filbin MR, Hooper DC, Camargo CA Jr. (2013) Clinical trial: comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial. Clin Infect Diseases: Official Publication Infect Dis Soc Am 56(12):1754–1762
doi: 10.1093/cid/cit122
Yadav K, Eagles D, Perry JJ, Taljaard M, Sandino-Gold G, Nemnom MJ, Corrales-Medina V, Suh KN, Stiell IG (2023) High-dose cephalexin for cellulitis: a pilot randomized controlled trial. Cjem 25(1):22–30
doi: 10.1007/s43678-022-00433-7
pubmed: 36592299
pmcid: 9807092
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097
doi: 10.1371/journal.pmed.1000097
pubmed: 19621072
pmcid: 2707599
Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, Ioannidis JP, Straus S, Thorlund K, Jansen JP et al (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 162(11):777–784
doi: 10.7326/M14-2385
pubmed: 26030634
Oremus M, Wolfson C, Perrault A, Demers L, Momoli F, Moride Y (2001) Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer’s disease drug trials. Dement Geriatr Cogn Disord 12(3):232–236
doi: 10.1159/000051263
pubmed: 11244218
Puhan MA, Schünemann HJ, Murad MH, Li T, Brignardello-Petersen R, Singh JA, Kessels AG, Guyatt GH (2014) A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ (Clinical Res ed) 349:g5630
Fujii T, Le Du F, Xiao L, Kogawa T, Barcenas CH, Alvarez RH, Valero V, Shen Y, Ueno NT (2015) Effectiveness of an adjuvant chemotherapy regimen for early-stage breast Cancer: a systematic review and network Meta-analysis. JAMA Oncol 1(9):1311–1318
doi: 10.1001/jamaoncol.2015.3062
pubmed: 26402167
pmcid: 5575939
Dias S, Welton NJ, Caldwell DM, Ades AE (2010) Checking consistency in mixed treatment comparison meta-analysis. Stat Med 29(7–8):932–944
doi: 10.1002/sim.3767
pubmed: 20213715
Dias S, Welton NJ, Sutton AJ, Caldwell DM, Lu G, Ades AE (2013) Evidence synthesis for decision making 4: inconsistency in networks of evidence based on randomized controlled trials. Med Decis Making: Int J Soc Med Decis Mak 33(5):641–656
doi: 10.1177/0272989X12455847
Bernard P, Plantin P, Roger H, Sassolas B, Villaret E, Legrain V, Roujeau JC, Rezvani Y, Scheimberg A (1992) Roxithromycin versus penicillin in the treatment of erysipelas in adults: a comparative study. Br J Dermatol 127(2):155–159
doi: 10.1111/j.1365-2133.1992.tb08048.x
pubmed: 1390144
Bernard P, Chosidow O, Vaillant L (2002) Oral pristinamycin versus standard penicillin regimen to treat erysipelas in adults: randomised, non-inferiority, open trial. BMJ (Clinical Res ed) 325(7369):864
doi: 10.1136/bmj.325.7369.864
Daniel R (1991) Azithromycin, erythromycin and cloxacillin in the treatment of infections of skin and associated soft tissues. European azithromycin Study Group. J Int Med Res 19(6):433–445
doi: 10.1177/030006059101900602
pubmed: 1663466
Griffith ME, Ellis MW (2013) Antimicrobial activity against CA-MRSA and treatment of uncomplicated nonpurulent cellulitis. Expert Rev anti-infective Therapy 11(8):777–780
doi: 10.1586/14787210.2013.816470
pubmed: 23944241
Ibrahim LF, Hopper SM, Orsini F, Daley AJ, Babl FE, Bryant PA (2019) Efficacy and safety of intravenous ceftriaxone at home versus intravenous flucloxacillin in hospital for children with cellulitis (CHOICE): a single-centre, open-label, randomised, controlled, non-inferiority trial. Lancet Infect Dis 19(5):477–486
doi: 10.1016/S1473-3099(18)30729-1
pubmed: 30853250
Kiani R (1991) Double-blind, double-dummy comparison of azithromycin and cephalexin in the treatment of skin and skin structure infections. Eur J Clin Microbiol Infect Diseases: Official Publication Eur Soc Clin Microbiol 10(10):880–884
doi: 10.1007/BF01975848
Montero L (1996) A comparative study of the efficacy, safety and tolerability of azithromycin and cefaclor in the treatment of children with acute skin and/or soft tissue infections. J Antimicrob Chemother 37(Suppl C):125–131
doi: 10.1093/jac/37.suppl_C.125
pubmed: 8818853
Thomas MGJIDCP (2014) Oral clindamycin compared with sequential intravenous and oral Flucloxacillin in the treatment of Cellulitis in adults: a Randomized. Double-Blind Trial 22(6):1
Zar FA (2017) Adding trimethoprim-sulfamethoxazole to cephalexin did not increase clinical cure in uncomplicated cellulitis. Ann Intern Med 167(8):Jc40
doi: 10.7326/ACPJC-2017-167-8-040
pubmed: 29049759
Jeong SH, Jang JH, Cho HY, Lee YB (2021) Population Pharmacokinetic Analysis of Cefaclor in healthy Korean subjects. Pharmaceutics 13(5)
Alsowaida YS, Benitez G, Bin Saleh K, Almangour TA, Shehadeh F, Mylonakis E (2022) Effectiveness and safety of Ceftriaxone compared to Standard of Care for Treatment of Bloodstream Infections due to Methicillin-Susceptible Staphylococcus aureus: a systematic review and Meta-analysis. Antibiotics 11(3):375
doi: 10.3390/antibiotics11030375
pubmed: 35326838
pmcid: 8944781
Ibrahim LF, Huang L, Hopper SM, Dalziel K, Babl FE, Bryant PA (2019) Intravenous ceftriaxone at home versus intravenous flucloxacillin in hospital for children with cellulitis: a cost-effectiveness analysis. Lancet Infect Dis 19(10):1101–1108
doi: 10.1016/S1473-3099(19)30288-9
pubmed: 31420292
Bernard P, Risse L, Bonnetblanc JM (1996) [Pristinamycin in the treatment of acute bacterial dermohypodermitis in adults. An open study of 42 patients]. Ann Dermatol Venereol 123(1):16–20
pubmed: 8734110
Oral alternative to (2002) Penicillin for adult erysipelas. Nurs Stand 17(13):10
doi: 10.7748/ns.17.13.10.s26
Schmutz JL, Trechot P (2014) [Skin rash mimicking pityriasis rosea Gibert secondary to pristinamycin therapy]. Ann Dermatol Venereol 141(4):325–326
doi: 10.1016/j.annder.2014.01.001
pubmed: 24703654
Delcroix F, Arnault JP, Chaby G, Gras-Champel V, Lok C (2016) A predominantly left-sided skin reaction to pristinamycin in a patient with right hemiplegia. JAAD case Rep 2(1):84–86
doi: 10.1016/j.jdcr.2015.11.011
pubmed: 27051837
pmcid: 4809482
Trottier ED, Farley St-Amand B, Vincent M, Chevalier I, Autmizguine J, Tremblay S, Gouin S (2022) Outpatient management of moderate cellulitis in children using high-dose oral cephalexin. Paediatr Child Health 27(4):213–219
doi: 10.1093/pch/pxac031
pubmed: 35859686
pmcid: 9291389
Mason JM, Thomas KS, Crook AM, Foster KA, Chalmers JR, Nunn AJ, Williams HC (2014) Prophylactic antibiotics to prevent cellulitis of the leg: economic analysis of the PATCH I & II trials. PLoS ONE 9(2):e82694
doi: 10.1371/journal.pone.0082694
pubmed: 24551029
pmcid: 3925077
Cranendonk DR, Opmeer BC, van Agtmael MA, Branger J, Brinkman K, Hoepelman AIM, Lauw FN, Oosterheert JJ, Pijlman AH, Sankatsing SUC et al (2020) Antibiotic treatment for 6 days versus 12 days in patients with severe cellulitis: a multicentre randomized, double-blind, placebo-controlled, non-inferiority trial. Clin Microbiol Infect 26(5):606–612
doi: 10.1016/j.cmi.2019.09.019
pubmed: 31618678
Yadav K, Krzyzaniak N, Alexander C, Scott AM, Clark J, Glasziou P, Keijzers G (2022) The impact of antibiotics on clinical response over time in uncomplicated cellulitis: a systematic review and meta-analysis. Infection 50(4):859–871
doi: 10.1007/s15010-022-01842-7
pubmed: 35593975
Mistry K, Sharma S, Patel M, Grindlay D, Janjuha R, Smart P, Levell NJ (2021) Clinical response to antibiotic regimens in lower limb cellulitis: a systematic review. Clin Exp Dermatol 46(1):42–49
doi: 10.1111/ced.14398
pubmed: 32860230