Prophylactic antibiotics for the prevention of cellulitis (erysipelas) of the leg: results of the UK Dermatology Clinical Trials Network's PATCH II trial

UK Dermatology Clinical Trials Network’s PATCH Trial Team

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Abstract

BACKGROUND: Cellulitis (erysipelas) of the leg is a common, painful infection of the skin and underlying tissue. Repeat episodes are frequent, cause significant morbidity and result in high health service costs.

OBJECTIVES: To assess whether prophylactic antibiotics prescribed after an episode of cellulitis of the leg can prevent further episodes.

METHODS: Double-blind, randomized controlled trial including patients recently treated for an episode of leg cellulitis. Recruitment took place in 20 hospitals. Randomization was by computer-generated code, and treatments allocated by post from a central pharmacy. Participants were enrolled for a maximum of 3 years and received their randomized treatment for the first 6 months of this period.

RESULTS: Participants (n=123) were randomized (31% of target due to slow recruitment). The majority (79%) had suffered one episode of cellulitis on entry into the study. The primary outcome of time to recurrence of cellulitis included all randomized participants and was blinded to treatment allocation. The hazard ratio (HR) showed that treatment with penicillin reduced the risk of recurrence by 47% [HR 0·53, 95% confidence interval (CI) 0·26-1·07, P=0·08]. In the penicillin V group 12/60 (20%) had a repeat episode compared with 21/63 (33%) in the placebo group. This equates to a number needed to treat (NNT) of eight participants in order to prevent one repeat episode of cellulitis [95% CI NNT(harm) 48 to ∞ to NNT(benefit) 3]. We found no difference between the two groups in the number of participants with oedema, ulceration or related adverse events.

CONCLUSIONS: Although this trial was limited by slow recruitment, and the result failed to achieve statistical significance, it provides the best evidence available to date for the prevention of recurrence of this debilitating condition.

Original languageEnglish
Pages (from-to)169-178
Number of pages10
JournalBritish Journal of Dermatology
Volume166
Issue number1
Early online date6 Dec 2011
DOIs
Publication statusPublished - Jan 2012

Keywords

  • Adolescent
  • Adult
  • Aged
  • Aged 80 and over
  • Anti-Bacterial Agents
  • Antibiotic Prophylaxis
  • Cellulitis
  • Costs and Cost Analysis
  • Double-Blind Method
  • Female
  • Hospitalization
  • Humans
  • Leg Dermatoses
  • Male
  • Medication Adherence
  • Middle Aged
  • Penicillin V
  • Secondary Prevention
  • Treatment Outcome
  • Young Adult
  • Journal Article
  • Multicenter Study
  • Randomized Controlled Trial

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