Clinical Question: Can cellulitis r...

Clinical Question: Can cellulitis requiring intravenous antibiotics be treated effectively at household and does this practice lead to greater patient satisfaction?

Setting: Outpatient (primary care)

reflection Design: Randomized controlled trial (single-blinded)

Allocation: Concealed

Synopsis: Investigators chronicleed 200 patients presenting to an unforeseen occasion department for whom intravenous antibiotic therapy was necessary. Patients with sum of two units or more signs of sepsis, morose cellulitis, or serious comorbidities were exclud After enrollment patients were assigned to hearthstone or in-hospital treatment. Before leaving, patients in the family circle treatment group received cefazolin in an initial dose of 2 g in the unforeseen occasion department, which was followed by way of a dosage of 2 g twice daily at abode (this same regimen was used in the hospital). A visiting nourish at the breast administered the antibiotic and the patients were visited daily by means of a primary care physician. Although this application of mind was performed in New Zealand, where domestic circle visits are common, additional subject of attention is prudent to determine whether encourages who visit the home twice daily can be under the orders of the same clinical monitoring function in countries in which family visits are not common.

The primary issue was the turnaround time (i.e., the number of days to no advancement of cellulitis), which was similar in the couple treatment groups (1.50 days in family versus 1.49 days in hospital). With regard to secondary results the number of days of intravenous therapy, the number of days to discharge (from treatment or hospital), and the number of days forward oral antibiotics also were similar between the sum of two units groups.

After common week, all patients were take a view ofed about their care; scores were similar in the one and the other groups. Significantly more patients receiving abode care reported being "very or quite" satisfied with the location of their treatment (93 versus 66 percent; P < 0001; number destitutioned to treat = four) and solely 5 percent of patients treated at to one's home expressed a preference for hospital care, while 35 percent of hospitalized patients would have preferr at-home care (P < 0001) single in eight patients treated at hearthstone required hospitalization. The study had the power (at 80 percent) to find a two-day difference in turnaround time, if as it was a difference truly existed.

Bottom Line: Patients requiring parenteral antibiotics for the treatment of cellulitis can be treated favorably at home, although some eventually will require hospitalization. In this close attention all patients had a telephone were visited daily at their primary care physician, and were visited twice daily according to a nurse. (Level of Evidence: lb)

close attention Reference: Corwin P, et al. Randomised controll trial of intravenous antibiotic treatment for cellulitis at residence compared with hospital. BMJ January 15 2005;330:129-35

Used with permission from Shaughnessy AF. IV treatment of cellulitis preferr in residence Accessed online March 1, 2005 at: http://wwwlnfoPOEMscom

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