Cellulitis: Oral antibiotics replace therapy of yesteryear

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Cellulitis: Oral antibiotics replace therapy of yesteryear

By Max Bloomfield
Agar plates
Methicillin-sensitive Staphylococcus aureus on aztreonam agar with disk susceptibility testing [Image: Supplied]

Clinical microbiologist Max Bloomfield reviews the treatment of cellulitis in the community and emphasises the benefits of using high-dose oral antibiotic therapy

Key points, High-dose oral antibiotic therapy is replacing intravenous therapy for many indications. Probenecid can be added to increase the half-life of many b, Pract Green w Pale Yellow
References

1. Iversen K, Ihlemann N, Gill SU, et al. Partial oral versus intravenous antibiotic treatment of endocarditis. N Engl J Med 2019;380(5):415–24.

2. Li HK, Rombach I, Zambellas R, et al. Oral versus intravenous antibiotics for bone and joint infection. N Engl J Med 2019;380(5):425–36.

3. Kaasch AJ, López-Cortés LE, Rodríguez-Baño J, et al. Efficacy and safety of an early oral switch in low-risk Staphylococcus aureus bloodstream infection (SABATO): an international, open-label, parallel-group, randomised, controlled, non-inferiority trial. Lancet Infect Dis 2024;24(5):523–34.

4. Dalen D, Fry A, Campbell SG, et al. Intravenous cefazolin plus oral probenecid versus oral cephalexin for the treatment of skin and soft tissue infections: a double-blind, non-inferiority, randomised controlled trial. Emerg Med J 2018;35(8):492–98.

5. Bowhay TR, Tsang T, Wei JCZ, et al. Oral antimicrobial therapy for cellulitis versus outpatient parenteral antimicrobial therapy: a single-centre audit of cellulitis outcomes. Intern Med J 2024;54(2):320–27.

6. Everts RJ, Gardiner SJ, Zhang M, et al. Probenecid effects on cephalexin pharmacokinetics and pharmacodynamics in healthy volunteers. J Infect 2021;83(2):182–89.

7. Taggart M, Langworthy K, Hui S, et al. Serological responses to Streptococcus pyogenes vaccine candidate antigens suggests that Streptococcus dysgalactiae is the predominant cause of lower limb cellulitis. Open Forum Infect Dis 2024;11(6):ofae272.

8. Balm M, Bupha-Intr O, Sinha T, et al. Incorporating patient, nursing and environmental factors into antimicrobial stewardship: effects of simplifying treatment from cefuroxime to ceftriaxone. N Z Med J 2024;137(1594):31–42.