Materiały źródłowe

• #1 Recurrent Cellulitis: Who is at Risk and How Effective is Antibiotic Prophylaxis?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9379124/

  Recurrent cellulitis following successful treatment is common and prevention should be a major component in the management of cellulitis. […] The role of non-antibiotic measures is important and should be first-line in prevention. Antibiotic prophylaxis is effective, but its role is limited to non-purulent cellulitis where risk factors are appropriately managed. […] Reducing the risk of recurrence involves the identification and management of risk factors and instituting preventative measures, which may include antibiotic prophylaxis. […] Initial management in the prevention of recurrent cellulitis involves the identification and management of risk factors. Published guidelines also recommend addressing these factors, either locally or systemically, in addition to antibiotic prophylaxis.

• #1 Recurrent Cellulitis: Who is at Risk and How Effective is Antibiotic Prophylaxis?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9379124/

  Chronic edema has been identified as a major risk factor for single-episode and recurrent cellulitis. […] Weight reduction and maintenance of a healthy weight in the obese individual may reduce recurrence and improve the success of antibiotic prophylaxis. […] Currently antibiotic prophylaxis is only indicated for non-purulent infection and directed against beta-hemolytic streptococci, particularly Streptococcus pyogenes. […] Prophylactic antibiotics have been used in recurrent cellulitis for over 40 years. […] Antibiotic prophylaxis for recurrent cellulitis can be considered when there are two or more episodes of cellulitis in the previous 12 months. […] A rigorous approach to the management of risk factors is important as the risk of recurrence increases with repeated episodes.

• #2 Cellulitis and erysipelas: prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4651026/

  Cellulitis is a common problem caused by spreading bacterial inflammation of the skin, with redness, pain, and lymphangitis. Up to 40% of people have systemic illness. […] Prophylactic antibiotics are more effective than no treatment at preventing recurrence of cellulitis or erysipelas infections. The protective effect of taking 6 to 12 months of prophylactic antibiotics may last up to 36 months. […] Although there is consensus that treatment of predisposing factors (e.g., lymphoedema, leg ulcers, toe web intertrigo, and traumatic wounds) can prevent recurrence of cellulitis or erysipelas, we found no RCTs that assessed this approach. […] We found one systematic review, which found that antibiotic prophylaxis reduced the risk of recurrent cellulitis compared with no antibiotic prophylaxis in people with a history of cellulitis.

• #3 Recurrent Cellulitis: Who is at Risk and How Effective is Antibiotic P | IJGM

  https://www.dovepress.com/recurrent-cellulitis-who-is-at-risk-and-how-effective-is-antibiotic-pr-peer-reviewed-fulltext-article-IJGM

  Recurrent cellulitis following successful treatment is common and prevention should be a major component in the management of cellulitis. […] The role of non-antibiotic measures is important and should be first-line in prevention. Antibiotic prophylaxis is effective, but its role is limited to non-purulent cellulitis where risk factors are appropriately managed. […] Initial management in the prevention of recurrent cellulitis involves the identification and management of risk factors. Published guidelines also recommend addressing these factors, either locally or systemically, in addition to antibiotic prophylaxis. […] Chronic edema has been identified as a major risk factor for single-episode and recurrent cellulitis. […] Weight reduction and maintenance of a healthy weight in the obese individual may reduce recurrence and improve the success of antibiotic prophylaxis.

• #3 Recurrent Cellulitis: Who is at Risk and How Effective is Antibiotic P | IJGM

  https://www.dovepress.com/recurrent-cellulitis-who-is-at-risk-and-how-effective-is-antibiotic-pr-peer-reviewed-fulltext-article-IJGM

  Currently antibiotic prophylaxis is only indicated for non-purulent infection and directed against beta-hemolytic streptococci, particularly Streptococcus pyogenes. […] Prophylactic antibiotics have been used in recurrent cellulitis for over 40 years. […] Antibiotic prophylaxis for recurrent cellulitis can be considered when there are two or more episodes of cellulitis in the previous 12 months. […] Phenoxymethylpenicillin is the preferred antibiotic for recurrent cellulitis prevention. […] The protective effect of antibiotics in preventing cellulitis is lost after cessation.

• #4 Cellulitis: How to prevent it from returning

  https://www.aad.org/public/diseases/a-z/cellulitis-self-care

  If youve had cellulitis, you have a higher risk of getting it again. Even after successful treatment, some people get cellulitis again and again. For most people, the cellulitis develops in the same place every time. […] This can help reduce your risk of getting cellulitis again. […] The following can help decrease your risk of getting cellulitis again: […] Treat wounds right away. If you injure your skin, immediately: Wash the wound with soap and water. Apply an antibiotic ointment. Cover the wound with a bandage. Clean and change the bandage every day (or as often as your doctor recommends) until the wound heals. […] Keeping your skin clean washes away bacteria that cause cellulitis. Moisturizing helps prevent cracks in your skin, which can let bacteria into your body. […] Treat infections promptly. An infection like athletes foot or impetigo can lead to cellulitis, so you want to treat it as soon as you notice signs.

• #4 Cellulitis: How to prevent it from returning

  https://www.aad.org/public/diseases/a-z/cellulitis-self-care

  Having another medical condition can increase your risk of getting cellulitis again. Working with your doctor to manage conditions like diabetes, eczema, leg ulcers, or periphery artery disease (PAD) can greatly reduce your cellulitis risk. […] Treat lymphedema (excessive fluid buildup that causes swelling, usually in an arm or leg). Of all the medical conditions that increase your risk of getting cellulitis again, lymphedema ranks highest. […] Research shows that if you are overweight or obese and lose weight, you reduce your risk of getting cellulitis again. […] If you continue to get cellulitis after doing what you can to reduce your risk, research shows that taking a low-dose antibiotic can help. This treatment may be recommended for someone who has had cellulitis three or four times in one year.

• #5 Cellulitis: Symptoms, Causes, Treatment & Recovery

  https://my.clevelandclinic.org/health/diseases/15071-cellulitis

  You can reduce your risk of developing cellulitis by: […] Cleaning your wounds or sores with antibacterial soap and water. […] Applying an antibiotic ointment on your wounds or sores. […] Covering your wounds or sores with a bandage to prevent dirt or bacteria from entering the area. […] Refraining from touching or rubbing your affected areas. […] Getting medical attention right away for any deep cuts or puncture wounds. […] To prevent cellulitis, be sure to practice proper hygiene. Clean any wounds with water and antibacterial soap and cover them with a clean bandage to reduce your risk of infection.

• #6 Cellulitis

  https://www.nhs.uk/conditions/cellulitis/

  Some people with recurring cellulitis might be prescribed low-dose long-term antibiotics to stop infections coming back. […] You can reduce the chances of getting cellulitis again by keeping skin clean and well moisturised. […] Cleaning any cuts or wounds and using antiseptic cream can help prevent cellulitis. […] Preventing cuts and scrapes by wearing appropriate clothing and footwear is also important for cellulitis prevention. […] Wearing gloves if working outside can help reduce the risk of cellulitis.

• #7 Cellulitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762

  If your cellulitis recurs, your health care provider may recommend preventive antibiotics. To help prevent cellulitis and other infections, take these precautions when you have a skin wound: […] Wash the wound daily with soap and water. Do this gently as part of your normal bathing. […] Ask your health care provider whether it would help to apply a protective cream or ointment. For most surface wounds, a nonprescription ointment (Vaseline, Polysporin, others) provides adequate protection. […] Cover the wound with a bandage. Change bandages at least daily. […] Watch for signs of infection. Irritation, pain and pus all signal possible infection and the need for medical care. […] People with diabetes or poor circulation need to take extra precautions to prevent skin injury. Good skin care includes the following:

• #7 Cellulitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762

  Inspecting your feet daily. Regularly check your feet for signs of injury so that you can catch infections early. […] Moisturizing your skin regularly. Lubricating the skin helps prevent cracking and peeling. Don’t apply moisturizer to open sores. […] Trimming your fingernails and toenails carefully. Take care not to injure the surrounding skin. […] Protecting your hands and feet. Wear footwear and gloves suitable to your activities. […] Promptly treating infections on the skin’s surface, such as athlete’s foot. Minor skin infections can easily spread from person to person. Treat fungal infections as soon as they occur.

• #8 Cellulitis: How to prevent recurrent episodes

  https://www.mayoclinic.org/diseases-conditions/cellulitis/expert-answers/cellulitis/faq-20058135

  To help prevent recurrent episodes of cellulitis a bacterial infection in the deepest layer of skin keep skin clean and well moisturized. Prevent cuts and scrapes by wearing appropriate clothing and footwear, using gloves when necessary, and trimming fingernails and toenails with care. Promptly treat any cuts or infections on the skin’s surface, such as athlete’s foot. […] If you frequently develop cellulitis, your doctor might recommend long-term antibiotic treatment to prevent recurrent infections.

• #9 Prevention of recurrent cellulitis | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/prevention-of-recurrent-cellulitis/

  Cellulitis can often recur, and studies have shown that up to 29% of admissions with cellulitis were due to repeat episodes. Prophylactic therapies and mitigating of risk factors have been recently shown to reduce recurrence. […] A randomised clinical trial (RCT) published in 2020 evaluated 84 patients with chronic (3 months) leg edema with history of two or more episodes of cellulitis in the same leg, comparing compression stocking therapy with controls. The trial was stopped early for efficacy, revealing a cellulitis recurrence of 15% in the compression group and 40% in the control group, suggesting a number needed to treat (NNT) of 4. […] In 2013, the PATCH-1 (Prophylactic Antibiotics for the Treatment of Cellulitis at Home) trial was published building on prior related trial results. This RCT recruited 274 participants to compare the effect of twelve months of low dose penicillin V 250mg PO BID with placebo in patients with at least two episodes of confirmed cellulitis of the leg in preceding 3 years. The penicillin group had a longer time to first recurrence and fewer repeat episodes during prophylaxis phase, yielding a NNT of 5 to prevent one recurrent cellulitis episode while on prophylaxis.

• #9 Prevention of recurrent cellulitis | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/prevention-of-recurrent-cellulitis/

  For patients with at least two episodes of lower-extremity cellulitis I consider prescribing 300mg PO BID for up to 12 months. Antibiotic prophylaxis has not been shown to prevent episodes after the period of prophylaxis is over. […] Skin care, optimising contributory medical conditions, and exercise may also be helpful in reducing recurrence.

• #10 Cellulitis | Johns Hopkins ABX Guide

  https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540106/all/Cellulitis

  Prevent edema: diuretics, limb elevation, compression stockings, and decongestive therapy. […] Keep skin hydrated using emollients. […] Treat dermatophytic infections, especially interdigital spaces on feet. […] Prevention of recurrent cellulitis, especially with lymphedema (consider if 3-4 episodes/ year and correction of underlying risk factors have been addressed already): Penicillin Vk 250-500mg PO twice daily, Amoxicillin 250-500mg PO twice daily, Erythromycin 250mg PO once or twice daily. […] Topical antibiotics are not effective.

• #11 Compression Therapy for Cellulitis Prevention | Lipedema

  https://www.lipedema.net/compression-therapy-for-cellulitis-prevention/

  Chronic swelling (also referred to as edema) in the legs is a risk factor for eventually developing cellulitis. […] Today, most doctors recommend conservative and preventative measures, such as daily washing of wounds or cuts that could be infiltrated by bacteria, and the application of protective creams, ointments, and bandages when necessary to surface wounds or extremely dry, flaky skin. Preventative medications, such as antibiotics, may be recommended in some instances where patients experience several recurrences of cellulitis. […] For people with poor circulation such as diabetics or women with Lipedema or Lymphedema, additional precautions for avoiding skin injury are recommended, but overall are still conservative and focus on healthy and consistent skincare. […] However, this study showed leg swelling from any cause puts affected individuals at risk for infections, and that compression helps reduce this risk.

• #11 Compression Therapy for Cellulitis Prevention | Lipedema

  https://www.lipedema.net/compression-therapy-for-cellulitis-prevention/

  If we can utilize the garments to decrease the levels of chronic edema, we may also decrease the chances of developing cellulitis. […] Compression may also reduce the rate at which the fat cells grow, and help to prevent fat disorders from progressing to more serious stages. […] Pneumatic compression pumps are a great at-home solution for patients suffering from lipedema or lymphedema, and potentially for cellulitis prevention. […] As we continue to monitor the development and new studies related to how these practices may help prevent the recurrence of cellulitis, we will update the data here as well.

• #12 Clinical Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by IDSA

  https://www.idsociety.org/practice-guideline/skin-and-soft-tissue-infections/

  IV. What Is Appropriate for the Evaluation and Treatment of Erysipelas and Cellulitis? […] Typical cases of cellulitis without systemic signs of infection should receive an antimicrobial agent that is active against streptococci (mild; Figure 1) (strong, moderate). For cellulitis with systemic signs of infection (moderate nonpurulent; Figure 1), systemic antibiotics are indicated. […] Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended (strong, moderate). […] In lower-extremity cellulitis, clinicians should carefully examine the interdigital toe spaces because treating fissuring, scaling, or maceration may eradicate colonization with pathogens and reduce the incidence of recurrent infection (strong, moderate).

• #13 Clinical Guidance for Group A Streptococcal Cellulitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/cellulitis.html

  Prevention focuses on good wound care. […] Early identification and management of superficial skin lesions is also key to cellulitis prevention. Patients with recurrent lower-extremity cellulitis should be inspected for tinea pedis (athlete’s foot) and it should be treated if present. Traumatic or bite wounds should be cleaned and managed appropriately (e.g., antibiotic prophylaxis, surgical debridement if indicated) to prevent secondary infections.

• #14 Recommendations | Cellulitis and erysipelas: antimicrobial prescribing | Guidance | NICE

  https://www.nice.org.uk/guidance/ng141/chapter/Recommendations

  Do not routinely offer antibiotic prophylaxis to prevent recurrent cellulitis or erysipelas. Give advice about seeking medical help if symptoms of cellulitis or erysipelas develop. […] For adults who have had treatment in hospital, or under specialist advice, for at least 2 separate episodes of cellulitis or erysipelas in the previous 12 months, specialists may consider a trial of antibiotic prophylaxis. Involve the person in a shared decision by discussing and taking account of: the severity and frequency of previous symptoms, the risk of developing complications, underlying conditions (such as oedema, diabetes or venous insufficiency) and their management, the risk of resistance with long-term antibiotic use, the person’s preference for antibiotic use. […] When antibiotic prophylaxis is given, give advice about: possible adverse effects of long-term antibiotics, returning for review within 6 months, seeking medical help if symptoms of cellulitis or erysipelas recur.

• #14 Recommendations | Cellulitis and erysipelas: antimicrobial prescribing | Guidance | NICE

  https://www.nice.org.uk/guidance/ng141/chapter/Recommendations

  Review antibiotic prophylaxis for recurrent cellulitis or erysipelas at least every 6 months. The review should include: assessing the success of prophylaxis, discussing continuing, stopping or changing prophylaxis (taking into account the person’s preferences for antibiotic use and the risk of antimicrobial resistance). Stop or change the prophylactic antibiotic to an alternative if cellulitis or erysipelas recurs.

• #15 Cellulitis and Erysipelas: Symptoms and Treatment | Doctor

  https://patient.info/doctor/cellulitis-and-erysipelas-pro

  Consensus is that any predisposing conditions should be treated to minimise risk of recurrence. This may include: […] For adults who have had treatment in hospital, or under specialist advice, for at least two separate episodes of cellulitis or erysipelas in the previous 12 months, specialists may consider a trial of antibiotic prophylaxis. […] First-choice antibiotic for prophylaxis is phenoxymethylpenicillin 250 mg twice a day. Erythromycin 250 mg twice a day if the patient is allergic to penicillin. […] Each recurrent episode of cellulitis results in further damage to the lymphatic system and is associated with additional morbidity and healthcare costs. […] One large study has shown that patients with two or more episodes of leg cellulitis who are given prophylactic penicillin for 12 months have fewer recurrences than those given placebo, without any increase in adverse effects. […] Antibiotic prophylaxis can prevent recurrent cellulitis even in those who have only had one previous episode of cellulitis.

• #16 Prophylactic Antibiotics May Be Best Bet for Preventing Cellulitis Recurrence – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/topics/infections/prophylactic-antibiotics-may-be-best-bet-for-preventing-cellulitis-recurrence/

  Antibiotic prophylaxis may be the best preventive treatment against recurrent cellulitis and erysipelas in patients who have had at least 2 episodes in 3 years; however, protection does not last following discontinuation of antibiotic therapy, according to a Cochrane review conducted by a team of Israeli investigators. […] The researchers concluded that antibiotic therapy is probably an effective preventive treatment for recurrent cellulitis of the lower limbs in patients receiving prophylactic treatment compared with patients receiving placebo or no treatment. […] Long-term antibiotic prophylaxis is also recommended, with evidence largely supported by observational studies and expert opinion. […] Moderate-certainty evidence based on 6 RCTs indicates that antibiotic prophylaxis is probably effective for preventing recurrent cellulitis and lengthening the time between recurrences. The protective effect is lost, however, once antibiotic prophylaxis is discontinued.

• #17 Long-term antibiotics likely to reduce risk of recurrent cellulitis

  https://evidence.nihr.ac.uk/alert/long-term-antibiotics-likely-to-reduce-risk-of-recurrent-cellulitis/

  Antibiotics may reduce the risk of leg cellulitis by about two-thirds in adults who have had at least two previous episodes, but only while they take the antibiotics. […] Existing guidelines recommend antibiotics to prevent recurrent cellulitis. They also advise careful skin care and treating conditions such as fungal infections and dryness that can allow bacteria through the skin. […] This review looked for prophylactic interventions for recurrent cellulitis but found most evidence for the use of antibiotics. Further evidence on alternative strategies such as compression stockings or exercises would be useful, given the need to prescribe antibiotics carefully. […] NICEs Clinical Knowledge Summary service recommends treating underlying risk factors such as breaks in the skin, oedema and obesity, to prevent recurrence of cellulitis. It advises considering referral to secondary care for advice on prophylactic antibiotics if someone has more than two episodes of cellulitis on the same site within a year. […] The Clinical Resource Efficiency Support Team published guidelines on the management of cellulitis in 2005. They recommend antibiotic prophylaxis in those who have had at least two episodes of cellulitis at the same site.

• #18 Impact of Monthly Prophylactic Antibiotics in Cellulitis | IDR

  https://www.dovepress.com/the-impact-of-monthly-prophylactic-antibiotics-use-in-patients-with-re-peer-reviewed-fulltext-article-IDR

  The vicious cycle of recurrent cellulitis ultimately results in a high risk of relapse, which facilitates the use of antibiotic prophylaxis with monthly intramuscular benzathine penicillin G (BPG) to prevent recurrence. […] Monthly intramuscular antibiotic prophylaxis was demonstrated to be effective in reducing cellulitis recurrence. Moreover, in the real-world practice, intramuscular clindamycin may serve as a reasonable alternative option to BPG. […] Antibiotic prophylaxis was found to be cost-effective, and is recommended by the IDSA guidelines for patients with recurrent cellulitis and those at risk of recurrence. […] The results indicate that both BPG and intramuscular clindamycin were effective prophylaxis for recurrent cellulitis. […] Following adjustment for multiple risk factors, both BPG and intramuscular clindamycin prophylaxis demonstrated a significant reduction in the risk of cellulitis recurrence compared to observation alone.

• #18 Impact of Monthly Prophylactic Antibiotics in Cellulitis | IDR

  https://www.dovepress.com/the-impact-of-monthly-prophylactic-antibiotics-use-in-patients-with-re-peer-reviewed-fulltext-article-IDR

  Overall, these studies suggest that prophylactic antibiotics may be an effective strategy for reducing the risk of recurrent cellulitis in patients with a history of multiple episodes. […] Therefore, the present study aimed to identify a suitable alternative option to monthly intramuscular antibiotics, and found that monthly intramuscular clindamycin was effective in preventing recurrent cellulitis when compared to observation alone.

• #19 Cellulitis treatment and prevention, Mukumi Clinic, Lymphedema Clinic Tokyo, Makoto Mihara – Mukumi Clinic, Lymphedema Clinic Tokyo, Japan

  https://www.english-mominoki-shinryosho.net/cellulitis/

  It is thought that about 30% of lymphedema patients develop cellulitis. […] If cellulitis occurs repeatedly, it becomes difficult for patients to travel or be involved with their hobbies and interests, etc. In addition, cellulitis may damage the lymphatic vessels and/or make the lymphedema worse. Patients who repeatedly suffer from cellulitis are therefore recommended to undergo appropriate treatment as soon as possible. […] Cellulitis prevention […] Compression therapy should be reconsidered. […] If the appropriate compression therapy is provided, involving elastic stockings, bandages, etc., cellulitis often does not develop. […] If cellulitis develops despite conservative therapy, surgery is recommended. Lymphatic venous anastomosis reduces the cellulitis rate to about one-eighth.

• #19 Cellulitis treatment and prevention, Mukumi Clinic, Lymphedema Clinic Tokyo, Makoto Mihara – Mukumi Clinic, Lymphedema Clinic Tokyo, Japan

  https://www.english-mominoki-shinryosho.net/cellulitis/

  The only prophylactic measures for cellulitis in use until now were physiotherapy and long-term oral antibiotic administration, but surgery has recently been accepted as an alternative. […] Treatment of lymphatic vesicles thus prevents the onset of cellulitis. […] It is now possible to inhibit lymphedema-complicating cellulitis using lymphatic venous anastomosis. Rather than suffering from cellulitis, which can ruin your life, you can instead undergo treatment that has a sound basis in scientific data, thus preventing cellulitis, so that you can enjoy the rest of your life.

• #20 Cellulitis – symptoms, treatment and causes | healthdirect

  https://www.healthdirect.gov.au/cellulitis

  Cellulitis is a bacterial infection of the skin spreading to the tissues under your skin. It can become serious if its not treated quickly with antibiotics. […] You can reduce your risk of developing cellulitis by: avoiding cuts, grazes and other injuries to your skin, maintaining good hygiene, managing skin conditions like tinea and eczema, maintaining a healthy weight, as obesity increases your risk of cellulitis. […] If you have ongoing swelling of your arm or leg due to a condition such as lymphoedema, you may develop cellulitis that keeps coming back. Ask your doctor about finding the cause of your swelling to help prevent this from happening. If you have cellulitis 2 or more times in a year, taking antibiotics for long periods can help.

• #21 Cellulitis in Nursing Homes: A Sign of Nursing Home Neglect

  https://nursinghomesabuse.org/nursing-home-injuries/infections/cellulitis/

  Cellulitis in elderly patients is a serious problem in nursing homes. Cellulitis is an infection caused by bacteria entering an opening on the skin. Infections like cellulitis can easily develop and spread among residents without meticulous care and strict adherence to disease-prevention protocols. Nursing homes have a duty to prevent and minimize the spread of infections. If nursing homes don’t provide a reasonable standard of care, they may be neglecting your loved ones, leading to infections that could be fatal. […] Preventing cellulitis in nursing homes requires a multifaceted approach that includes maintaining a clean environment, adhering to proper hygiene practices, providing appropriate wound care, and managing underlying health conditions. Here are some key strategies for preventing cellulitis in nursing homes: Encourage regular hand washing among residents and staff to minimize the spread of bacteria

• #21 Cellulitis in Nursing Homes: A Sign of Nursing Home Neglect

  https://nursinghomesabuse.org/nursing-home-injuries/infections/cellulitis/

  Maintain cleanliness in the nursing home by regularly sanitizing common areas, bathrooms, and residents’ living spaces […] Monitor residents for skin breakdown or injuries, and provide prompt and appropriate wound care […] Implement pressure ulcer prevention measures for bedridden or immobile residents […] Appropriately manage residents’ underlying health conditions to reduce the risk of cellulitis […] Provide regular skin assessments and moisturize dry skin to maintain its integrity and reduce the risk of cracks and injuries […] Ensure that medical devices such as catheters and IV lines are properly inserted, maintained, and removed to minimize the risk of introducing bacteria into the skin […] Provide ongoing education and training for nursing home staff to ensure they are aware of the risk factors, prevention strategies, and early signs of cellulitis […] Encourage nursing home staff to promptly report any suspected cases of cellulitis to health care professionals to initiate timely diagnosis and treatment.

• #22 Prophylactic Antibiotics to Prevent Cellulitis of the Leg: Economic Analysis of the PATCH I & II Trials | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0082694

  Cellulitis (erysipelas) is a recurring and debilitating bacterial infection of the skin and underlying tissue. We assessed the cost-effectiveness of prophylactic antibiotic treatment to prevent the recurrence of cellulitis using low dose penicillin V in patients following a first episode (6 months prophylaxis) and more recurrent cellulitis (12 months prophylaxis, or 6 months in those declining 12 months). […] Following first episode or recurrent cellulitis of the leg, prophylactic low dose penicillin is a very low cost intervention which, on balance, is effective and cost-effective at preventing subsequent attacks. Antibiotic prophylaxis reduces cellulitis recurrence by nearly a third but is not associated with a significant increase in costs. […] Economic analysis of the PATCH trials suggests that a policy of antibiotic prophylaxis is likely, on balance, to be cost-effective for patients both with first episode and recurrent cellulitis. The clinical implication is that antibiotic prophylaxis reduces cellulitis recurrence by nearly a third and is not associated with a significant increase in cost.

• #23 Prophylactic antibiotics to prevent cellulitis of the leg: « metajournal.com

  https://www.metajournal.com/articles/183809/prophylactic-antibiotics-prevent-cellulitis-leg-economic-analysis-patch-ii?from_stub=true

  Prophylactic antibiotics to prevent cellulitis of the leg: economic analysis of the PATCH I II trials. […] Following first episode or recurrent cellulitis of the leg, prophylactic low dose penicillin is a very low cost intervention which, on balance, is effective and cost-effective at preventing subsequent attacks. […] Antibiotic prophylaxis reduces cellulitis recurrence by nearly a third but is not associated with a significant increase in costs.

• #24 Is Prevention Possible? Antibiotic Prophylaxis for Recurrent Lower Extremity Cellulitis

  https://geripal.org/antibiotic-prophylaxis-for-recurrent-cellulitis/

  In patients with recurrent lower extremity cellulitis, do prophylactic antibiotics, compared to no treatment, reduce the recurrence rate of lower extremity cellulitis? […] Analysis revealed that prophylactic antibiotics were beneficial for preventing recurrent cellulitis (RR 0.46, 95% CI 0.26-0.79) with a number needed to treat (NNT) of 5 patients. […] The review supports the positive impact of antibiotics for prophylaxis against recurrent cellulitis in the United Kingdom. […] However, for future patients who struggle with recurrent cellulitis, the low NNT and low risk of side effects makes prescribing prophylactic antibiotic a treatment to consider.

• #25 Antibiotic Prophylaxis May Help Prevent Recurrent Cellulitis – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/news/antibiotic-prophylaxis-may-help-prevent-recurrent-cellulitis/

  Antibiotic prophylaxis can prevent recurrence of cellulitis, according to a review published online in the Cochrane Library. […] The researchers found that antibiotic prophylaxis correlated with reduced risk of recurrence compared with no treatment or placebo (risk ratio [RR], 0.31; 95% CI, 0.13-0.72) based on data from 5 trials. […] Compared with no treatment or placebo, antibiotic prophylaxis decreased the cellulitis incidence rate (RR, 0.44; 95% CI, 0.22-0.89) and significantly decreased the rate until the next episode of cellulitis (hazard ratio [HR], 0.51; 95% CI, 0.34-0.78). […] Larger, high-quality studies are warranted, including long-term follow-up and other prophylactic measures, the authors write.

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