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Adjunctive clindamycin for cellulitis: a clinical trial comparing flucloxacillin
with or without clindamycin for the treatment of limb cellulitis
#MMPMID28314743
Brindle R
; Williams OM
; Davies P
; Harris T
; Jarman H
; Hay AD
; Featherstone P
BMJ Open
2017[Mar]; 7
(3
): e013260
PMID28314743
show ga
OBJECTIVE: To compare flucloxacillin with clindamycin to flucloxacillin alone for
the treatment of limb cellulitis. DESIGN: Parallel, double-blinded, randomised
controlled trial. SETTING: Emergency department attendances and general practice
referrals within 20 hospitals in England. INTERVENTIONS: Flucloxacillin, at a
minimum of 500?mg 4 times per day for 5?days, with clindamycin 300?mg 4 times per
day for 2?days given orally versus flucloxacillin given alone. MAIN OUTCOME
MEASURES: The primary outcome was improvement at day 5. This was defined as being
afebrile with either a reduction in affected skin surface temperature or a
reduction in the circumference of the affected area. Secondary outcomes included
resolution of systemic features, resolution of inflammatory markers, recovery of
renal function, reduction in the affected area, decrease in pain, return to work
or normal activities and the absence of increased side effects. RESULTS: 410
patients were included in the trial. No significant difference was seen in
improvement at day 5 for flucloxacillin with clindamycin (136/156, 87%) versus
flucloxacillin alone (140/172, 81%)-OR 1.55 (95% CI 0.81 to 3.01), p=0.174. There
was a significant difference in the number of patients with diarrhoea at day 5 in
the flucloxacillin with clindamycin allocation (34/160, 22%) versus
flucloxacillin alone (16/176, 9%)-OR 2.7 (95% CI 1.41 to 5.07), p=0.002. There
was no clinically significant difference in any secondary outcome measures. There
was no significant difference in the number of patients stating that they had
returned to normal activities at the day 30 interview in the flucloxacillin with
clindamycin allocation (99/121, 82%) versus flucloxacillin alone (104/129,
81%)-adjusted OR 0.90 (95% CI 0.44 to 1.84). CONCLUSIONS: The addition of a short
course of clindamycin to flucloxacillin early on in limb cellulitis does not
improve outcome. The addition of clindamycin doubles the likelihood of diarrhoea
within the first few days. TRIAL REGISTRATION NUMBER: NCT01876628, Results.
|Adult
[MESH]
|Aged
[MESH]
|Anti-Bacterial Agents/*therapeutic use
[MESH]
|Cellulitis/*drug therapy
[MESH]
|Clindamycin/adverse effects/*therapeutic use
[MESH]
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