title: Meta-analysis of randomised trials comparing a penicillin or cephalosporin with a macrolide or lincosamide in the treatment of cellulitis or erysipelas.
abstract: OBJECTIVE
  Beta-lactam antibiotics, such as penicillin, flucloxacillin or cephalexin, are widely considered first-line treatment for cellulitis and erysipelas, while macrolides and lincosamides, such as erythromycin, azithromycin or clindamycin, are widely considered second-line agents. We attempted to determine whether outcomes differed between patients treated either with a beta-lactam or with a macrolide or lincosamide.
  
  
  METHODS
  We conducted a meta-analysis of published trials in which patients with cellulitis or erysipelas were randomised to treatment either with a beta-lactam or with a macrolide or lincosamide. We searched PUBMED, EMBASE, MEDLINE and SCOPUS (up to March 2014) using the terms: cellulitis/erysipelas, penicillin/beta-lactam, macrolide/lincosamide, random*/controlled*/trial* as keywords. We included randomised trials that compared monotherapy with a beta-lactam with monotherapy with a macrolide or lincosamide for cellulitis or erysipelas.
  
  
  RESULTS
  We identified 15 studies, 9 in patients with cellulitis or erysipelas and 6 in patients with various skin and soft tissue infections including cellulitis and erysipelas. The efficacy of treatment of cellulitis or erysipelas was similar with a beta-lactam [27/221 (12 %) not cured] and a macrolide or lincosamide [21/241 (9 %) not cured, RR 1.24, 95 % CI 0.72-2.41, p = 0.44]. Treatment efficacy was also similar for skin or soft tissue infections including cellulitis and erysipelas (RR 1.28, 95 % CI 0.96-1.69, p = 0.09). Risk of adverse effects was similar for beta-lactams [148/1295 (11 %) not cured] and macrolides or lincosamides [228/1737 (13 %) not cured, RR 0.86, 95 % CI 0.64-1.16, p = 0.31].
  
  
  CONCLUSIONS
  Treatment with a macrolide or lincosamide for cellulitis or erysipelas has a similar efficacy and incidence of adverse effects as treatment with a beta-lactam.
authors.affiliation: Department of Infectious Diseases, Auckland City Hospital, Auckland, 1142, New Zealand.
authors.forename: Athena
authors.initials: A
authors.lastname: Ferreira
authors.affiliation: Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, 1142, New Zealand.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Bolland
authors.affiliation: Department of Infectious Diseases, Auckland City Hospital, Auckland, 1142, New Zealand. mg.thomas@auckland.ac.nz.|Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, 1142, New Zealand. mg.thomas@auckland.ac.nz.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Thomas
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000188:drug therapy*; D002511:Cephalosporins / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004886:Erysipelas / Q000188:drug therapy*; D006801:Humans; D055231:Lincosamides / Q000627:therapeutic use*; D018942:Macrolides / Q000627:therapeutic use*; D010406:Penicillins / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D055231:Lincosamides; D018942:Macrolides; D010406:Penicillins; D047090:beta-Lactams
keywords: Betalactams; Cellulitis; Lincosamides; Macrolides; Meta-analysis