title: Once-daily intravenous cefazolin plus oral probenecid is equivalent to once-daily intravenous ceftriaxone plus oral placebo for the treatment of moderate-to-severe cellulitis in adults.
abstract: A once-daily regimen of cefazolin (2 g intravenously [iv]) plus probenecid (1 g by mouth) was compared with a once-daily regimen of ceftriaxone (1 g iv) plus oral placebo in a randomized, double-blind equivalence trial of home-based therapy for moderate-to-severe cellulitis in adults. For the assessable recipients of cefazolin-probenecid (n=59) and ceftriaxone-placebo (n=57), clinical cure occurred at the end of treatment in 86% and 96% (P=.11), respectively, and was maintained at 1 month of follow-up in 96% and 91% (P=.55), respectively. The mean number of treatment doses (+/-standard deviation) given was similar in the 2 treatment arms (6.97+/-2.6 for cefazolin-probenecid and 6.12+/-2.1 for ceftriaxone-placebo; P=.06). The median antibiotic trough concentrations were 2.35 microgram/mL for cefazolin and 15.45 microgram/mL for ceftriaxone. Patients in the 2 treatment arms were similar with regard to overall rates of adverse reaction (P=.15), but nausea was more common among those in the cefazolin-probenecid arm (P=.048). The once-daily regimen of cefazolin-probenecid is a cheap, practical, and effective treatment option for moderate-to-severe cellulitis, and it avoids the need to use third-generation cephalosporins in most patients.
authors.affiliation: Infectious Diseases Department, Austin & Repatriation Medical Centre, Heidelberg, Victoria 3084, Australia. Lindsay.Grayson@armc.org.au
authors.forename: M Lindsay
authors.initials: ML
authors.lastname: Grayson
authors.forename: Malcolm
authors.initials: M
authors.lastname: McDonald
authors.forename: Kimberley
authors.initials: K
authors.lastname: Gibson
authors.forename: Eugene
authors.initials: E
authors.lastname: Athan
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Munckhof
authors.forename: Phillip
authors.initials: P
authors.lastname: Paull
authors.forename: Fran
authors.initials: F
authors.lastname: Chambers
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002437:Cefazolin / Q000009:adverse effects / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000009:adverse effects / Q000627:therapeutic use*; D002481:Cellulitis / Q000188:drug therapy*; D002511:Cephalosporins / Q000009:adverse effects / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010919:Placebos / Q000627:therapeutic use*; D011339:Probenecid / Q000009:adverse effects / Q000627:therapeutic use*; D014528:Uricosuric Agents / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D002511:Cephalosporins; D010919:Placebos; D014528:Uricosuric Agents; D002443:Ceftriaxone; D002437:Cefazolin; D011339:Probenecid