title: Daptomycin-Based 3 Week Treatment Scheme for the First Cellulitis Episode: Low Recurrence Rate Indicative of Decreased Recurrence Propensity?
abstract: BACKGROUND
  Cellulitis recurrences are frequent, difficult to manage, and contribute considerably to overall disease burden. This retrospective cases series reports recurrence rates of first community-acquired lower limb disease episode initially treated with daptomycin.
  
  
  METHODS
  Treatment consisted of a 21-day two substances sequential scheme: intravenous daptomycin (4 mg/kg/day) during hospitalization and roxithromycin (2 × 150 mg per os) afterwards. Primary study end-point was the rate of recurrences during follow-up; recurrence rates and their binomial 95% confidence intervals (CI) were calculated with SPSS 22.0. Recurrences were identified by (1) review of hospital records and (2) telephone questionnaires.
  
  
  RESULTS
  Twenty-seven patients hospitalized for first lower limb cellulitis episodes were started on daptomycin and 26 patients completed the above three-week sequential treatment scheme. During follow-up (range 37-85 months) one recurrence occurred among the 26 patients who completed the treatment: 96.2% of these patients remained relapse free at the end of follow-up (CI 79.5-99.9%). Considering also treatment failure, the overall effectiveness of this combination treatment was 92.6% recurrence free after more than 3 years follow-up (25/27 patients; CI 75.5-99.0%). This study is limited by retrospective planning and the restricted number of included patients.
  
  
  CONCLUSIONS
  The choice of the treatment for the initial lower limb cellulitis episode may impact the risk of disease recurrences. Future studies should explore interventions for the first cellulitis episode as a means to modify the risk of the recurring course of this disease.
authors.affiliation: Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, Ioannina, Greece. ibassuka@cc.uoi.gr.
authors.forename: Ioannis D
authors.identifier: http://orcid.org/0000-0002-0252-8314
authors.initials: ID
authors.lastname: Bassukas
authors.affiliation: Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Chaniotakis
authors.affiliation: Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gaitanis
keywords: Cellulitis; Daptomycin; Erysipelas; Leg; Lower limb; Recurrence; Roxithromycin
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