• 
• 

Three Part Question

Amongst [patients with cellulitis], does [treatment with high dose cephalosporins compared to standard dose cephalosporins] lead to [improved patient cure and fewer treatment failures]?

Clinical Scenario

A 46-year-old female patient presents to the emergency department with a warm to touch, painful, and erythematous rash on their right leg. No previous methicillin-resistant staphylococcus aureus colonization documented in the past. You are considering which outpatient oral antibiotic strategy would be most appropriate for this patient for suspected cellulitis.

Search Strategy

Ovid MEDLINE(R) and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations and Daily 1946 to January 25, 2024
([exp cellulitis OR cellulitis.mp] AND [cephalosporin.mp OR exp cephalosporins OR cephalexin.mp OR exp cephalexin OR cefuroxime.mp. OR exp cefuroxime OR cefaclor.mp. OR exp cefaclor OR cefadrine.mp. OR exp cefaclor OR cefadrine.mp OR exp cefadroxil OR cefixime.mp OR exp cefixime OR cefalexin] AND [dose.mp])

Inclusion criteria: Primary studies (including grey literature) which explored the relationship between cephalosporin dosing strategies and clinical cure or treatment failure rates, amongst patients who were clinically suspected to have cellulitis.

Exclusion criteria: 1) Review papers; 2) studies which did not perform a head-to-head comparison between cephalosporin dosing strategies and treatment outcome amongst patients with cellulitis; 3) studies with antibiotic strategies that did not include cephalosporins.

Search Outcome

A total of 60 papers were initially identified of which one paper was directly relevant to the three-part research question. Three papers did evaluate high-dose cephalosporins in the treatment of cellulitis; however, these papers did not perform a direct comparison between high-dose and standard-dose cephalosporins and were thus excluded. Otherwise, the search strategy had two review papers and 54 papers which did not answer our question and, thus, were additionally excluded.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

The pilot randomized controlled trial suggests that completing a full-scale trial to investigate high-dose cephalexin (1000 mg PO QID x 7 days) compared to low dose cephalexin (500 mg PO QID x 7 days) in the treatment of adult patients with cellulitis is possible.

Clinical Bottom Line

Amongst patients with cellulitis, there is insufficient evidence to date exploring the relationship between cephalosporin dose and clinical cure or treatment failure rates.

References

1. Yadav K, Eagles D, Perry JJ, Taljaard M, Sandino-Gold G, Nemnom MJ, Corrales-Medina V, Suh KN, Stiell IG High-dose cephalexin for cellulitis: a pilot randomized controlled trial Canadian Journal of Emergency Medicine 2023 Jan 25; 22-30