Sunday, August 12, 2012

Once or twice-daily, algorithm-based intravenous cephazolin for home-based cellulitis treatment.

Once or twice-daily, algorithm-based intravenous cephazolin for home-based cellulitis treatment.

Aug 2012


Department of Pharmacy Acute Post Acute Care, Central Coast Local Health District, Gosford Faculty of Biomedical Science, University of Newcastle, Newcastle, New South Wales, Australia.


Objective: Cellulitis is a common presentation to the ED and a significant cause of hospitalization that can be managed in hospital-in-the-home programmes. Current clinical-practice guidelines recommend once or twice-daily i.v. antibiotics; however, there is an absence of data describing the impact of these guidelines in real-world practice-based settings. This study aims to describe the safety and effectiveness of home-based cellulitis treatment according to an online treatment algorithm. 

Methods: Over 12 months, 301 patients with a diagnosis of uncomplicated cellulitis requiring i.v. antibiotics and eligible for home-based therapy completed once-daily (cephazolin plus probenecid) or twice-daily (cephazolin alone) treatment, according to the treatment algorithm. Time (days) until non-progression of cellulitis was the primary outcome measure. Length of stay and treatment-related side-effects were also recorded. Results: The mean time until non-progression was 2.11 (95% confidence interval [CI] 1.98-2.23) days versus 2.13 (95% CI 1.81-2.45) days for the once-daily (n = 213) and twice-daily (n = 88) regimens, respectively (P = 0.92, difference in means 0.02 [95% CI -0.36-0.33]). The corresponding mean length of stay was 6.55 (95% CI 5.96-7.15) days versus 7.67 (95% CI 6.69-8.65) days (P = 0.06, difference in means 1.12 [CI 0.03-1.23]). Treatment-related side-effects were reported in 15.5% (33/213 [95% CI 10.6-20.3]) of patients receiving the once-daily regimen compared with 9.1% (8/88 [95% CI 3.1-15.1]) treated twice-daily. Application of the once-daily strategy increased hospital-in-the-home cellulitis-related treatment capacity by 52% (1396/2688 [95% CI 50-54]). 

Conclusions: An online decision support algorithm can support the effective use of a once or twice-daily treatment regimen for uncomplicated cellulitis. This approach can increase the efficiency and capacity of home-based therapy, resulting in better alignment of treatment options with clinicians and patients' preferences.

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