A Randomised Comparative Study of Once-Daily Ceftriaxone and 6-Hourly Flucloxacillin in the Treatment of Moderate to Severe Cellulitis

Summary

In a study comparing flucloxacillin (1g every 6 hours intravenously), as standard treatment for moderate to severe cellulitis, with ceftriaxone (1g once daily intravenously), ceftriaxone was found to be an effective alternative to flucloxacillin without the associated risk of serious cholestatic hepatitis.

Forty-seven evaluable patients, 24 in the ceftriaxone group and 23 in the flucloxacillin group, were evaluated in this prospective randomised study examining clinical efficacy, safety and duration of hospitalisation. 22 of 23 (96%) patients in the ceftriaxone group achieved clinical success (clinical cure and improvement), while 16 of 22 (70%) flucloxacillin patients were considered a clinical success (clinical cure and improvement). Baseline bacteriology was not performed in the single patient who did not respond to ceftriaxone, while 5 of the 6 patients who did not respond to flucloxacillin had a negative baseline culture. The remaining flucloxacillin failure was infected with Staphylococcus aureus, which persisted at the post-treatment evaluation. All other pathogens isolated at baseline in both treatment arms were eradicated at the post-treatment bacteriological evaluation.

No serious or unexpected adverse events were reported in either group. Because it requires only once-daily administration, ceftriaxone made it possible for some patients to be treated as outpatients, resulting in an average reduction of 3.04 hospital bed-days, while at the same time being as efficacious as flucloxacillin.