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The impact of antibiotics on clinical response over time in uncomplicated cellulitis: a systematic review and meta-analysis

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Abstract

Purpose

Antibiotic treatment of uncomplicated cellulitis is highly variable with respect to agent, dose, and route of administration. As there is uncertainty about optimal/appropriate time to reassess, we aimed to assess time to clinical response.

Methods

We conducted a systematic review of randomized controlled trials reporting clinical response of uncomplicated cellulitis to antibiotic treatment over multiple timepoints. PubMed, Embase, CENTRAL, WHO ICTRP, and clinicaltrials.gov were searched from inception to June 2021 without language restrictions. The primary outcome was time to clinical response. Other outcomes were components of clinical response (pain, severity score, redness, edema measured at ≥ 2 timepoints) and the proportion of patients with treatment failure. We performed a pooled estimate of the average time to clinical response together with 95% confidence intervals using a random effects model.

Results

We included 32 randomized controlled trials (n = 13,576 participants). The mean time to clinical response was 1.68 days (95%CI 1.48–1.88; I2 = 76%). The response to treatment for specific components was as follows: ~ 50% reduction of pain and severity score by day 5, a ~ 33% reduction in area of redness by day 2–3, and a 30–50% reduction of proportion of patients with edema by day 2–4. Treatment failure was variably defined with an overall failure rate of 12% (95%CI 9–16%).

Conclusion

The best available data suggest the optimal time to clinical reassessment is between 2 and 4 days, but this must be interpreted with caution due to considerable heterogeneity and small number of included studies.

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Data availability

Registration: The protocol was registered and is available on the Open Science Framework (https://osf.io/ktbpx/).

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Clinical Epidemiology Unit, Department of Emergency Medicine, University of Ottawa, 1053 Carling Avenue, F660b, Ottawa, ON, K1Y4E9, Canada

    Krishan Yadav

  2. Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Krishan Yadav

  3. Institute for Evidence-Based Healthcare, Bond University, Robina, Australia

    Natalia Krzyzaniak, Anna Mae Scott, Justin Clark & Paul Glasziou

  4. Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia

    Charlotte Alexander & Gerben Keijzers

  5. Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia

    Charlotte Alexander & Gerben Keijzers

  6. School of Medicine, Griffith University, Gold Coast, QLD, Australia

    Gerben Keijzers

Authors
  1. Krishan Yadav
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  2. Natalia Krzyzaniak
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  3. Charlotte Alexander
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  4. Anna Mae Scott
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  5. Justin Clark
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  7. Gerben Keijzers
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Correspondence to Krishan Yadav.

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Yadav, K., Krzyzaniak, N., Alexander, C. et al. The impact of antibiotics on clinical response over time in uncomplicated cellulitis: a systematic review and meta-analysis. Infection 50, 859–871 (2022). https://doi.org/10.1007/s15010-022-01842-7

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  • DOI: https://doi.org/10.1007/s15010-022-01842-7

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