Abstract | OBJECTIVE:
Cellulitis is a common presentation to the ED and a significant cause of hospitalization that can be managed in hospital-in-the-home programmes. Current clinical-practice guidelines recommend once or twice-daily i.v. antibiotics; however, there is an absence of data describing the impact of these guidelines in real-world practice-based settings. This study aims to describe the safety and effectiveness of home-based cellulitis treatment according to an online treatment algorithm. METHODS: Over 12 months, 301 patients with a diagnosis of uncomplicated cellulitis requiring i.v. antibiotics and eligible for home-based therapy completed once-daily ( cephazolin plus probenecid) or twice-daily ( cephazolin alone) treatment, according to the treatment algorithm. Time (days) until non-progression of cellulitis was the primary outcome measure. Length of stay and treatment-related side-effects were also recorded. RESULTS: The mean time until non-progression was 2.11 (95% confidence interval [CI] 1.98-2.23) days versus 2.13 (95% CI 1.81-2.45) days for the once-daily (n = 213) and twice-daily (n = 88) regimens, respectively (P = 0.92, difference in means 0.02 [95% CI -0.36-0.33]). The corresponding mean length of stay was 6.55 (95% CI 5.96-7.15) days versus 7.67 (95% CI 6.69-8.65) days (P = 0.06, difference in means 1.12 [CI 0.03-1.23]). Treatment-related side-effects were reported in 15.5% (33/213 [95% CI 10.6-20.3]) of patients receiving the once-daily regimen compared with 9.1% (8/88 [95% CI 3.1-15.1]) treated twice-daily. Application of the once-daily strategy increased hospital-in-the-home cellulitis-related treatment capacity by 52% (1396/2688 [95% CI 50-54]). CONCLUSIONS: An online decision support algorithm can support the effective use of a once or twice-daily treatment regimen for uncomplicated cellulitis. This approach can increase the efficiency and capacity of home-based therapy, resulting in better alignment of treatment options with clinicians and patients' preferences.
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Authors | Tim Garrett, Yvonne Harbort, Mary Trebble, Toni Docherty |
Journal | Emergency medicine Australasia : EMA
(Emerg Med Australas)
Vol. 24
Issue 4
Pg. 383-92
(Aug 2012)
ISSN: 1742-6723 [Electronic] Australia |
PMID | 22862755
(Publication Type: Journal Article)
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Copyright | © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine. |
Chemical References |
- Anti-Bacterial Agents
- Cefazolin
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Topics |
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Algorithms
- Anti-Bacterial Agents
(administration & dosage, adverse effects)
- Cefazolin
(administration & dosage, adverse effects)
- Cellulitis
(drug therapy)
- Disease Progression
- Female
- Home Care Services
- Humans
- Injections, Intravenous
- Length of Stay
- Male
- Middle Aged
- New South Wales
- Prospective Studies
- Young Adult
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