Efficacy of Cephalexin Monotherapy for Cellulitis
SOURCE: Moran GJ, Krishnadasan A, Mower WR, et al. JAMA 2017;317:2088-2096.
The past decade has seen methicillin-resistant Staphylococcus aureus (MRSA) maintain sufficient prevalence in cases of acute cutaneous abscesses that treatment oriented to that pathogen, typically trimethoprim-sulfamethoxazole or doxycycline, has become routine adjunctive treatment to incision and drainage. The pathogen responsible for cellulitis without abscess often has been assumed to involve MRSA frequently, leading to similar treatment regimens. Although nailing down with certainty the etiologic agent of cellulitis presents greater difficulty than an abscess, the currently predominant cellulitis pathogen is believed to be beta-hemolytic strep. In typical clinical settings, the pathogen usually is not identified prior to treatment initiation. If MRSA is not a major player in simple cellulitis (without abscess), might agents to address MRSA be omitted safely?
A randomized, clinical trial of cellulitis patients (n = 500) without evidence of abscess compared cephalexin + trimethoprim-sulfamethoxazole to cephalexin monotherapy. The primary outcome was clinical cure.
There was no statistically significant difference in the primary outcomes for the two groups, with a higher than 80% success rate in both treatment arms. In the absence of evidence of purulent infection, these data support the use of cephalexin treatment (500 mg four times daily for seven days) as a simpler, less expensive antimicrobial regimen.
Data support the use of cephalexin treatment as a simpler, less expensive antimicrobial regimen.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.