WHAT'S NEW?: Evidence that low-dose penicillin is effective
This trial provides strong evidence that a lower dose of penicillin than is currently recommended by the IDSA (250 mg vs 1 g BID) is effective in reducing leg cellulitis recurrence. It also shows that 12 months of prophylaxis significantly reduces the risk of recurrent leg cellulitis, but that the effect may diminish when the penicillin is stopped.
CAVEATS: Questions about dose and duration remain
Participant characteristics predictive of prophylaxis failure in this study included BMI≥33 and ≥3 previous episodes of cellulitis. It could be that patients with higher BMIs need a higher dose of penicillin. And we still don’t know whether prophylactic treatment for longer than 12 months would provide continued benefit, what the optimal time period for prophylactic antibiotics should be, and whether the higher recommended dose of penicillin would be more effective than the low dose that was used in this study. Antibiotic resistance associated with long-term penicillin use is a concern, as well.
challenges to implementation
Even when we know that patients are likely to benefit, we are often hesitant to prescribe long-term antibiotics because of reasonable fears of resistance and adverse effects.
Acknowledgement
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.
