Meta-analysis of randomised trials comparing a penicillin or cephalosporin with a macrolide or lincosamide in the treatment of cellulitis or erysipelas

• Published in: Infection Vol. 44; no. 5; pp. 607 - 615
• Main Authors: Ferreira, Athena, Bolland, Mark J., Thomas, Mark G.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2016; Springer Nature B.V
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotics; beta-Lactams - therapeutic use; Cellulitis - drug therapy; Cephalosporins - therapeutic use; Drug Therapy, Combination; Erysipelas - drug therapy; Family Medicine; General Practice; Humans; Infectious Diseases; Internal Medicine; Lincosamides - therapeutic use; Macrolides - therapeutic use; Medicine; Medicine & Public Health; Original Paper; Penicillins - therapeutic use; Randomized Controlled Trials as Topic; Side effects; Cellulitis; Betalactams; Macrolides; Lincosamides; Meta-analysis
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-016-0895-x

Purpose Beta-lactam antibiotics, such as penicillin, flucloxacillin or cephalexin, are widely considered first-line treatment for cellulitis and erysipelas, while macrolides and lincosamides, such as erythromycin, azithromycin or clindamycin, are widely considered second-line agents. We attempted to determine whether outcomes differed between patients treated either with a beta-lactam or with a macrolide or lincosamide. Methods We conducted a meta-analysis of published trials in which patients with cellulitis or erysipelas were randomised to treatment either with a beta-lactam or with a macrolide or lincosamide. We searched PUBMED, EMBASE, MEDLINE and SCOPUS (up to March 2014) using the terms: cellulitis/erysipelas, penicillin/beta-lactam, macrolide/lincosamide, random*/controlled*/trial* as keywords. We included randomised trials that compared monotherapy with a beta-lactam with monotherapy with a macrolide or lincosamide for cellulitis or erysipelas. Results We identified 15 studies, 9 in patients with cellulitis or erysipelas and 6 in patients with various skin and soft tissue infections including cellulitis and erysipelas. The efficacy of treatment of cellulitis or erysipelas was similar with a beta-lactam [27/221 (12 %) not cured] and a macrolide or lincosamide [21/241 (9 %) not cured, RR 1.24, 95 % CI 0.72–2.41, p  = 0.44]. Treatment efficacy was also similar for skin or soft tissue infections including cellulitis and erysipelas (RR 1.28, 95 % CI 0.96–1.69, p  = 0.09). Risk of adverse effects was similar for beta-lactams [148/1295 (11 %) not cured] and macrolides or lincosamides [228/1737 (13 %) not cured, RR 0.86, 95 % CI 0.64–1.16, p  = 0.31]. Conclusion Treatment with a macrolide or lincosamide for cellulitis or erysipelas has a similar efficacy and incidence of adverse effects as treatment with a beta-lactam.