Comparison of initial antibiotic choice and treatment of cellulitis in the pre- and post–community-acquired methicillin-resistant Staphylococcus aureus eras☆

Abstract 

Treatment success of cellulitis in the age of community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA). A comparison of initial antibiotic choice and treatment success in the pre- and post-CAMRSA eras.

Objective

The objective of this study is to determine antibiotic prescribing patterns and treatment failure rates for cellulitis in the pre- and post-CAMRSA eras.

Methods

We performed an electronic chart review of patients seen in our emergency department with cellulitis in 2000 and 2005. Inclusion criteria included age 18 years or more and received a single oral antibiotic for cellulitis. Exclusion criteria were incision and drainage, surgery, or admission on initial visit. Treatment failure was defined as a repeat visit in the subsequent 30 days and a change in antibiotics, admission to the hospital, incision and drainage of abscess, or surgical intervention. Antibiotic-prescribing practices and treatment failure rates were then compared in the pre- and post-CAMRSA eras.

Results

There was a significant decrease in β-lactam antibiotics and an increase in CAMRSA-effective antibiotics prescribed in 2005 vs 2000. The difference in treatment failure rates of the β-lactams and CAMRSA antibiotics was statistically insignificant. There has not been an increase in failure rates of the β-lactam antibiotics for simple cellulitis since the emergence of CAMRSA.

Conclusion

Our study demonstrates that prescribing practices for simple cellulitis have changed since the emergence of CAMRSA. This may not be appropriate because β-lactam antibiotics perform as well as ‘CAMRSA antibiotics’ in our study.