High-dose Cephalexin for Cellulitis (HI-DOCC)

Launched by OTTAWA HOSPITAL RESEARCH INSTITUTE · May 1, 2023

Keywords

ClinConnect Summary

Background Non-purulent cellulitis is a bacterial skin and soft tissue infection of the subcutaneous tissue. Group A streptococcus (Streptococcus pyogenes), beta-hemolytic streptococci and methicillin-susceptible Staphylococcus aureus are the most common bacteria causing non-purulent cellulitis. Patients typically present to the emergency department (ED) with pain, redness, swelling and induration (skin hardening due to inflammation) of the affected skin. A minority of patients may have fever or tachycardia. The diagnosis of cellulitis is clinical. Once the diagnosis is made, antibiotic tre...

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Eligibility criteria

• Inclusion Criteria:
• • Adults (age ≥18 years) diagnosed with non-purulent cellulitis and determined by the treating emergency physician to be eligible for outpatient oral antibiotics.
• Exclusion Criteria:
• • 1. Age \<18 years;
• • 2. Patient already taking oral antibiotics;
• • 3. Treating physician decides IV antibiotics are required;
• • 4. Abscess requiring an incision and drainage procedure;
• • 5. Known prior cellulitis secondary to methicillin-resistant Staphylococcus aureus (MRSA);
• • 6. Cellulitis secondary to a human or animal bite wound;
• • 7. Penetrating wound or water exposure resulting in cellulitis;
• • 8. Surgical site infection;
• • 9. Patient found at a follow up visit to have an alternative, non-infectious etiology (e.g., deep vein thrombosis);
• • 10. bilateral symptoms (e.g., both legs involved);
• • 11. Malignancy and currently being treated with chemotherapy;
• • 12. Solid organ or bone marrow transplant recipient;
• • 13. Renal impairment with an estimated glomerular filtration rate \<30 mL/min documented on the health record at any time within the past three months;
• • 14. Allergy to cephalosporins or history of anaphylaxis to penicillin;
• • 15. Inability to provide informed consent