Dataset Information

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

ABSTRACT:

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).

SUBMITTER: Yadav K

PROVIDER: S-EPMC9807092 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Publications

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

Yadav Krishan K Eagles Debra D Perry Jeffrey J JJ Taljaard Monica M Sandino-Gold Gabriel G Nemnom Marie-Joe MJ Corrales-Medina Vicente V Suh Kathryn N KN Stiell Ian G IG

CJEM 20230102 1

<h4>Background</h4>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.<h4>Objectives</h4>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.<h4>Methods</h4>A parallel arm double-blind rand ...[more]

PMID: 36592299

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Dataset Information

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

Background

Objectives

Methods

Results

Conclusion

Trial registration

Publications

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

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